Influence of emergency department patient volumes on CT utilization rate of the physician in triage.

BACKGROUND: Physician in triage (PIT) has been used as a potential solution to emergency department (ED) overcrowding and to decrease ED length of stay (LOS). This study examined the relationship between computerized tomography (CT) utilization of PIT and ED patient volumes. We hypothesized that despite the pressure on PIT to improve throughput on the busiest days, they will continue to utilize CT at the same rate. METHODS: This retrospective chart review evaluated CT ordering patterns of PIT on patients with abdominal pain who presented to the ED over a 6-year period. CT utilization rate was calculated on days with the lowest 5% (LD5) and highest 5% (HD5) volumes based on average yearly volume. CT positive and negative rates were correlated with volume using Chi square analysis. Odds ratio and confidence intervals were calculated for the magnitude of effect difference. RESULTS: We found no statistically significant difference in CT utilization rate on HD5 vs LD5 (p = 0.833). There was a statistically significant increase in the rate of negative CT scans on HD5 (p = 0.046) which represented a 17% relative difference. LOS was longer on HD5 (p = 0.013) and when a CT scan was ordered (p < 0.001). CONCLUSION: No difference was found in the rate at which the PIT ordered CT scans on high volume vs low volume days. The rate of CT scans without clinically relevant findings did increase slightly on high volume days. LOS was longer on high volume days and when a CT was ordered.

Severe-intensity constant-work-rate cycling indicates that ramp incremental cycling underestimates ⩒o2max in a heterogeneous cohort of sedentary individuals.

In the absence of a ⩒o2-work-rate plateau, debate continues regarding the best way to verify that the peak ⩒o2 achieved during incremental exercise (⩒o2peak) is the "true ⩒o2max." Oft-used "secondary criteria" have been questioned in conjunction with the contention that a severe-intensity constant-work-rate "verification bout" should be considered the "gold standard." The purpose of this study was to compare the ⩒o2peak during ramp incremental cycling (RAMP-INC) by a heterogeneous (with respect to body composition and sex) cohort of sedentary individuals with the ⩒o2peak during severe-intensity constant-work-rate cycling (CWR) performed after RAMP-INC at the highest work rate achieved. A secondary purpose was to determine the degree to which traditional and newly-proposed age-dependent secondary criteria (RER, HR) identified RAMP-INC which CWR confirmed were characterized by a submaximal ⩒o2peak. Thirty-five healthy male (n = 19: 33.4 ± 6.3 yrs) and female (26.8 ± 3.6 yrs) sedentary participants performed RAMP-INC followed by CWR. The ⩒o2peak values from the two tests were correlated (r = 0.96; p < 0.01; mean CV = 24%); however, ⩒o2peak for CWR was significantly greater (29.6 ± 7.2 v. 28.6 ± 6.8 mL∙min-1∙kg-1; p < 0.01) with a mean bias of 0.98 mL∙min-1∙kg-1 (z = -2.9, p < 0.01). Both traditional and newly-proposed criterion values for RER were achieved during RAMP-INC by 33 of 35 participants (including 21 of 23 who registered a higher ⩒o2peak on CWR). The traditional HR criterion value was achieved on only seven tests (three of which were confirmed to be characterized by a submaximal ⩒o2peak) while use of less stringent newly-proposed criteria resulted in acceptance of an additional seven tests of which five were confirmed to be submaximal. Severe-intensity CWR to limit of tolerance indicates that RAMP-INC underestimates ⩒o2max in sedentary individuals and both traditional and newly-proposed secondary criteria are ineffective for identifying such tests.