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1.
Radiology ; 298(3): 622-629, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33434109

RESUMO

Background Multidetector CT (MDCT) enables rapid and accurate diagnosis of head and neck (HN) injuries in patients with blunt trauma (BT). However, MDCT is overused, and appropriate selection of patients for imaging could improve workflow. Purpose To investigate the effect of implementing clinical triaging algorithms on use of MDCT in the HN in patients who have sustained BT. Materials and Methods In this retrospective study, patients aged 15 years or older with BT admitted between October 28, 2007, and December 31, 2013, were included. Patients were divided into pre- and postalgorithm groups. The institutional trauma registry and picture archiving and communication system reports were reviewed to determine which patients underwent MDCT of the head, MDCT of the cervical spine (CS), and MDCT angiography of the HN at admission and whether these examinations yielded positive results. Injury Severity Score, Acute Physiology and Chronic Health Evaluation II score (only those patients in the intensive care unit), length of hospital stay (LOS), length of intensive care unit stay (ICULOS), and mortality were obtained from the trauma registry. Results A total of 8999 patients (mean age, 45 years ± 20 [standard deviation]; age range, 15-101 years; 6027 male) were included in this study. A lower percentage of the postalgorithm group versus the prealgorithm group underwent MDCT of the head (55.8% [2774 of 4969 patients]; 95% CI: 54.4, 57.2 vs 64.2% [2589 of 4030 patients]; 95% CI: 62.8, 65.7; P < .001) and CS (49.4% [2452 of 4969 patients]; 95% CI: 48.0, 50.7 vs 60.5% [2438 of 4030 patients]; 95% CI: 59.0, 62.0; P < .001) but not MDCT angiography of the HN (9.7% [480 of 4969 patients]; 95% CI: 8.9, 10.5 vs 9.8% [393 of 4030 patients]; 95% CI: 8.9, 10.7; P > .99). Pre- versus postalgorithm groups did not differ in LOS (mean, 4.8 days ± 7.1 vs 4.5 days ± 7.1, respectively; P = .42), ICULOS (mean, 4.6 days ± 6.6 vs 4.8 days ± 6.7, respectively; P > .99), or mortality (2.9% [118 of 4030 patients]; 95% CI: 2.5, 3.5; vs 2.8% [141 of 4969 patients]; 95% CI: 2.4, 3.3; respectively; P > .99). Conclusion Implementation of a clinical triaging algorithm resulted in decreased use of multidetector CT of the head and cervical spine in patients who experienced blunt trauma, without increased adverse outcomes. © RSNA, 2021 See also the editorial by Munera and Martin in this issue.


Assuntos
Traumatismos Craniocerebrais/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Lesões do Pescoço/diagnóstico por imagem , Triagem/métodos , Ferimentos não Penetrantes/diagnóstico por imagem , APACHE , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Traumatismos Craniocerebrais/mortalidade , Feminino , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/mortalidade , Seleção de Pacientes , Estudos Retrospectivos , Ferimentos não Penetrantes/mortalidade
2.
Cornea ; 36(4): 406-410, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28060029

RESUMO

PURPOSE: This study evaluates the correlation between corneal densitometry and epithelial ingrowth (EI) after laser in situ keratomileusis (LASIK). METHODS: Corneal densitometry of 3 patients who developed EI after LASIK was measured with the Oculus Pentacam. Corneal densitometry readings of each patient were obtained preoperatively and postoperatively after ingrowth was discovered. Densitometry was recorded at the central nest of opacity and at the leading edges of EI. RESULTS: For all patients, the most severe stages of EI observed on slit-lamp photographs correlated with the highest densitometry readings, with peak densitometry ranging from 73.3 to 95.1. These values were much higher than preoperative densitometry readings, which ranged from 21.8 to 27.2. In 2 cases, the Pentacam densitometry map revealed progression of EI toward the visual axis that was only faintly detectable or not detectable at all on the corresponding slit-lamp photographs. CONCLUSIONS: Corneal densitometry seems to be an objective measure of the severity and progression of EI after LASIK.


Assuntos
Doenças da Córnea/diagnóstico , Epitélio Corneano/patologia , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Doenças da Córnea/etiologia , Paquimetria Corneana , Densitometria , Feminino , Humanos , Lasers de Excimer , Masculino , Pessoa de Meia-Idade , Fotografação/métodos , Procedimentos Cirúrgicos Refrativos , Estudos Retrospectivos , Acuidade Visual/fisiologia , Adulto Jovem
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