ABSTRACT
Background: Clinical imaging guidelines assist doctors in selecting the most appropriate radiological investigation(s) according to the patient's clinical presentation and also help to avoid unnecessary radiation exposure. Objectives: This study aimed to determine the appropriateness of choice of imaging procedures requested by the doctors in the Accident and Emergency Department (A&E) of Kenyatta National Hospital (KNH). Method: Request forms sent to the KNH Radiology Department from the A&E Department from 01 July 2019 to 31 October 2019 were captured digitally. The request forms were de-identified to ensure confidentiality of patients and requesting doctors. Only the demographic data, clinical summary and radiological examination requested were extracted. Results: A total of 1053 imaging request forms were captured and analysed using the American College of Radiology (ACR) appropriateness criteria. Adequate clinical summary was provided in 81.3% of the request forms. Appropriate imaging requests were 51.9% whilst inappropriate imaging requests were 34.6%. The clinical scenarios of 13.6% of the imaging requests were not found in the ACR database. Imaging modalities using ionising radiation formed the bulk of the inappropriate investigations at 72.8%. Of these, CT scan had the highest individual inappropriate requests of 49.3%. Only 18.4% of female patients in the reproductive age group had a documented last menstrual period. Conclusion: Imaging modalities using ionising radiation had the highest percentage of inappropriate radiological requests, especially CT scans requested in the trauma setting. In addition, some clinical scenarios were not captured in the ACR appropriateness criteria, hence the need for local imaging guidelines.
ABSTRACT
BACKGROUND: Emergencies in the radiology department may arise in critically ill patients who are brought to the department for imaging, interventional procedures or as a result of adverse reactions to contrast media used for imaging. Adverse reactions to contrast media range from minor to severe life-threatening effects and initial, prompt management decreases complications. Radiology staff must possess knowledge of the management of anaphylactic or anaphylactoid contrast reactions and cardiopulmonary arrest (CPA) as they are likely to be the first responders. OBJECTIVES: To determine the knowledge and practices amongst radiologists, radiology residents and radiographers in the management of CPA and adverse reactions to contrast media. METHOD: This cross-sectional study was performed between March and August 2016 at Kenyatta National Hospital using a questionnaire. RESULTS: Eighty participants were enrolled. None answered all the questions correctly, with only 55% of radiologists, 35% of residents and 39% of radiographers scoring above 50%. The majority (82%) of participants had adequate knowledge regarding the symptoms, signs and risk factors of adverse reactions to contrast media; however, only 30% knew that intravenous epinephrine is the recommended therapy for a severe anaphylactic reaction. Shortcomings in terms of adequate training were found in this study, with the majority of respondents having not attended any life support course in the preceding 5 years. CONCLUSION: Health providers within the radiology unit had knowledge about identifying both mild and severe symptoms of anaphylactic reactions. However, there were knowledge gaps regarding the management of these reactions.
