The Alvarado score should be used to reduce emergency department length of stay and radiation exposure in select patients with abdominal pain
| Autor: | Peter M. Hammer, Jamie J. Coleman, Matthew S. Field, Stephanie A. Savage, Tyrone Rogers, Grace S. Rozycki, David V. Feliciano, Bryan W. Carr, Brian L. Brewer, Ben L. Zarzaur |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Abdominal pain MEDLINE Computed tomography Critical Care and Intensive Care Medicine Decision Support Techniques 03 medical and health sciences 0302 clinical medicine medicine Humans 030212 general & internal medicine Retrospective Studies medicine.diagnostic_test business.industry Retrospective cohort study Emergency department Length of Stay Radiation Exposure medicine.disease Appendicitis Abdominal Pain Radiation exposure Alvarado score 030220 oncology & carcinogenesis Surgery Female Radiology medicine.symptom business Emergency Service Hospital Tomography X-Ray Computed |
| Zdroj: | The journal of trauma and acute care surgery. 84(6) |
| ISSN: | 2163-0763 |
| Popis: | Abdominal pain is the common reason patients seek treatment in emergency departments (ED), and computed tomography (CT) is frequently used for diagnosis; however, length of stay (LOS) in the ED and risks of radiation remain a concern. The hypothesis of this study was the Alvarado score (AS) could be used to reduce CT scans and decrease ED LOS for patients with suspected acute appendicitis (AA).A retrospective review of patients who underwent CT to rule out AA from January 1, 2015, to December 31, 2015, was performed. Patient demographics, medical history, ED documentation, operative interventions, complications, and LOS were all collected. Alvarado score was calculated from the medical record. Time to CT completion was calculated from times the patient was seen by ED staff, CT order, and CT report.Four hundred ninety-two patients (68.1% female; median age, 33 years) met the inclusion criteria. Most CT scans (70%) did not have findings consistent with AA. Median AS for AA on CT scan was 7, compared with 3 for negative CT (p0.001). One hundred percent of female patients with AS of 10 and males with AS of 9 or greater had AA confirmed by surgical pathology. Conversely, 5% or less of female patients with AS of 2 or less and 0% of male patients with AS of 1 or less were diagnosed with AA. One hundred six (21.5%) patients had an AS within these ranges and collectively spent 10,239 minutes in the ED from the time of the CT order until the radiologist's report.Males with an AS of 9 or greater and females with AS of 10 should be considered for treatment of AA without imaging. Males with AS of 1 or less and females with AS of 2 or less can be safely discharged with follow-up. Using AS, a significant proportion of patients can avoid the radiation risk, the increased cost, and increased ED LOS associated with CT.Diagnostic IV, therapeutic IV. |
| Databáze: | OpenAIRE |
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