Availability of a final abdominopelvic CT report before emergency department disposition: risk-adjusted outcomes in patients with abdominal pain.

OBJECTIVE: To determine whether availability of a final radiologist report versus an experienced senior resident preliminary report prior to disposition affects major care outcomes in emergency department (ED) patient presenting with abdominal pain undergoing abdominopelvic CT. MATERIALS AND METHODS: This single-institution, IRB-approved, HIPAA-compliant retrospective cohort study included 5019 ED patients with abdominal pain undergoing abdominopelvic CT from October 2015 to April 2019. Patients were categorized as being dispositioned after either an experienced senior resident preliminary report (i.e., overnight model) or the final attending radiologist interpretation (i.e., daytime model) of the CT was available. Multivariable regression models were built accounting for demographic data, clinical factors (vital signs, ED triage score, laboratory data), and disposition timing to analyze the impact on four important patient outcomes: inpatient admission (primary outcome), readmission (within 30 days), second operation within 30 days, and death. RESULTS: In the setting of an available experienced senior resident preliminary report, timing of the final radiologist report (before vs. after disposition) was not a significant multivariable predictor of inpatient admission (p = 0.63), readmission within 30 days (p = 0.66), second operation within 30 days (p = 0.09), or death (p = 0.63). Unadjusted event rates for overnight vs daytime reports, respectively, were 37.2% vs. 38.0% (inpatient admission), 15.9% vs. 16.5% (30-day readmission), 0.65% vs. 0.3% (second operation within 30 days), and 0.85% vs. 1.3% (death). CONCLUSION: Given the presence of an experienced senior resident preliminary report, availability of a final radiology report prior to ED disposition did not affect four major clinical care outcomes of patients with abdominal pain undergoing abdominopelvic CT.

Inexpensive telecytology solutions that use the Raspberry Pi and the iPhone.

INTRODUCTION: There is currently substantial interest in dynamic telecytology-the presentation of microscopic findings by live video feed to a cytopathologist at a remote location. However, the initial costs of a telecytology system can be high. We present several low-cost alternatives along with their performance characteristics. MATERIALS AND METHODS: We tested 3 low-cost telecytology systems: a Raspberry Pi with a webcam, an iPhone 4S with FaceTime, and an iPhone 4S with a live streaming app. Costs, resolution capacities, and latency periods for image transmission were determined. RESULTS: At $85.55, the Raspberry Pi system is the least expensive telecytology solution described to date. When the cost per megapixel of resolution is considered, the cost of a Raspberry Pi system is 120× less than the most expensive commercially available option and about 7-fold less than the iPhone-based alternatives. Latency periods were substantially lower for the iPhone systems: 2.5 ± 1 seconds for FaceTime and 2.8 ± 0.3 seconds for iPhone live streaming versus 6.6 ± 0.6 seconds for the Raspberry Pi system at comparable frame rates. CONCLUSIONS: This proof-of-principle study demonstrates that inexpensive telecytology systems are able to stream live video feeds of cytology slides from a microscope to a remote location at useable resolutions.