Imaging of frequent emergency department users with alcohol use disorders.

BACKGROUND: Patients with altered level of consciousness secondary to alcohol use disorders (AUDs) often undergo imaging in the emergency department (ED), although the frequency and yield of this practice over time are unknown. STUDY OBJECTIVES: We describe the use of imaging, the associated ionizing radiation exposure, cumulative costs, and identified acute and chronic injuries and abnormalities among frequent users of the ED with AUDs. METHODS: This is a retrospective case series of individuals identified through an administrative database having 10 or more annual ED visits in 2 consecutive years who were prospectively followed for a third year. International Classification of Diseases, 9(th) Revision, Clinical Modification and Current Procedural Terminology codes were used to select individuals with alcohol-related diagnoses, track imaging procedures, and calculate cost. Diagnoses, imaging results, and radiation exposure per computed tomography (CT) study were abstracted from the medical record. RESULTS: Fifty-one individuals met inclusion criteria and had a total of 1648 imaging studies over the 3-year period. Subjects had a median of 5 (interquartile range [IQR] 2-10) CT scans, 20 (IQR 10-33) radiographs, 28.3 mSv (IQR 8.97-61.71) ionizing radiation, 0.2% (IQR 0.07-0.4) attributable risk of cancer, and $2979 (IQR 1560-5440) in charges using a national rate. The incidence of acute fracture or intracranial head injury was 55%, and 39% of the cohort had a history of moderate or severe traumatic brain injury. CONCLUSION: The remarkable use of imaging and occurrence of injury among these highly vulnerable and frequently encountered individuals compels further study to refine clinical practices through the development of evidence-based, effective interventions.

Diagnóstico del síndrome coronario agudo en los servicios de urgencias: mejoras durante la primera década del siglo XXI / Diagnosis of acute coronary syndrome in the emergency department: improvements from the first decade of the twenty-first century

Los métodos diagnósticos y la estratificación del riesgo de los pacientes que presentan sintomatología compatible con síndrome coronario agudo (SCA) han evolucionado considerablemente durante la pasada década. El SCA, aunque potencialmente mortal, puede presentarse de una forma notablemente larvada. Los recientes avances en las técnicas diagnósticas de imagen y en los biomarcadores son prometedores, y esta revisión sitúa estos avances desde una perspectiva histórica. Esperamos que los avances que suponen los descubrimientos que se describen en esta revisión conviertan en obsoletas muchas de las dificultades inherentes de los protocolos actuales para “descartar un infarto agudo de miocardio” y constituyan la base de una metodología precisa, racionaly rápida para diagnosticar el SCA en los servicios de urgencias (AU)

The methods of diagnosis and risk stratification of patients who present with signs and symptoms of a possible acutecoronary syndrome (ACS) have evolved considerably over the past decade. ACS, although potentially lethal, can benotoriously subtle in presentation. Recent advances in diagnostic imaging and cardiac biomarkers hold promise, and this review places current advances in a historical context. It is our hope that advancements rooted in the discoveries described in this review will render as obsolete many of the existing difficulties inherent to the current protocol for "ruling out myocardial infarction," and form the foundation for an accurate, comprehensive, and rapid methodology for diagnosing ACS in the emergency department (AU)