Subjects -> HEALTH AND SAFETY (Total: 1566 journals)
    - CIVIL DEFENSE (22 journals)
    - DRUG ABUSE AND ALCOHOLISM (86 journals)
    - HEALTH AND SAFETY (744 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (390 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (109 journals)
    - PHYSICAL FITNESS AND HYGIENE (133 journals)
    - WOMEN'S HEALTH (82 journals)

HEALTH FACILITIES AND ADMINISTRATION (390 journals)                  1 2 | Last

Showing 1 - 200 of 401 Journals sorted alphabetically
Academy of Health Care Management Journal     Full-text available via subscription   (Followers: 13)
ACI Open     Open Access  
Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
Administration and Policy in Mental Health and Mental Health Services Research     Partially Free   (Followers: 22)
Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi     Open Access   (Followers: 1)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 17)
Advances in Dual Diagnosis     Hybrid Journal   (Followers: 48)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Medical Education and Practice     Open Access   (Followers: 34)
Advances in Mental Health and Intellectual Disabilities     Hybrid Journal   (Followers: 89)
Advances in Nursing Science     Hybrid Journal   (Followers: 43)
Advances in Simulation     Open Access   (Followers: 7)
African Journal of Primary Health Care & Family Medicine     Open Access   (Followers: 6)
AIDS and Behavior     Hybrid Journal   (Followers: 18)
American Journal of Hospice and Palliative Medicine     Hybrid Journal   (Followers: 48)
American Journal of Managed Care     Full-text available via subscription   (Followers: 13)
Analytical Methods     Full-text available via subscription   (Followers: 14)
Anthropologie et santé     Open Access   (Followers: 5)
Applied Clinical Informatics     Hybrid Journal   (Followers: 5)
Applied Health Economics and Health Policy     Full-text available via subscription   (Followers: 24)
Applied Research in Quality of Life     Hybrid Journal   (Followers: 13)
Archives of Public Health     Open Access   (Followers: 13)
Asian Journal of Health     Open Access   (Followers: 4)
Australasian Journal of Paramedicine     Open Access   (Followers: 7)
Australian and New Zealand Journal of Public Health     Hybrid Journal   (Followers: 17)
Australian Health Review     Hybrid Journal   (Followers: 7)
Australian Journal of Primary Health     Hybrid Journal  
Australian Journal of Rural Health     Hybrid Journal   (Followers: 18)
Autism     Hybrid Journal   (Followers: 349)
Avicenna     Open Access   (Followers: 3)
Balint Journal     Hybrid Journal   (Followers: 2)
Bereavement Care     Hybrid Journal   (Followers: 13)
BJR     Hybrid Journal   (Followers: 21)
BMC Medical Informatics and Decision Making     Open Access   (Followers: 25)
BMC Oral Health     Open Access   (Followers: 7)
BMJ Leader     Hybrid Journal  
BMJ Quality & Safety     Hybrid Journal   (Followers: 69)
BMJ Supportive & Palliative Care     Hybrid Journal   (Followers: 50)
British Journal of Healthcare Assistants     Full-text available via subscription   (Followers: 33)
British Journal of Healthcare Management     Full-text available via subscription   (Followers: 19)
British Journal of Hospital Medicine     Full-text available via subscription   (Followers: 18)
British Journal of Nursing     Full-text available via subscription   (Followers: 294)
British Journal of School Nursing     Full-text available via subscription   (Followers: 14)
Bruce R Hopkins' Nonprofit Counsel     Hybrid Journal   (Followers: 2)
Building Better Healthcare     Full-text available via subscription   (Followers: 1)
Canadian Nurse     Full-text available via subscription   (Followers: 8)
Cardiac Electrophysiology Clinics     Full-text available via subscription   (Followers: 1)
Children and Schools     Hybrid Journal   (Followers: 8)
Chinese Medical Record English Edition     Hybrid Journal  
CIN : Computers Informatics Nursing     Hybrid Journal   (Followers: 11)
Clinical Audit     Open Access   (Followers: 4)
Clinics and Practice     Open Access  
Cognition, Technology & Work     Hybrid Journal   (Followers: 14)
Communication & Medicine     Hybrid Journal   (Followers: 5)
Community Based Medical Journal     Open Access  
Conflict and Health     Open Access   (Followers: 8)
Contemporary Nurse : A Journal for the Australian Nursing Profession     Hybrid Journal   (Followers: 7)
Critical Public Health     Hybrid Journal   (Followers: 26)
Culture, Health & Sexuality: An International Journal for Research, Intervention and Care     Hybrid Journal   (Followers: 17)
Current Opinion in Supportive and Palliative Care     Hybrid Journal   (Followers: 28)
Das Gesundheitswesen     Hybrid Journal   (Followers: 10)
Death Studies     Hybrid Journal   (Followers: 22)
Dental Nursing     Full-text available via subscription   (Followers: 3)
Disaster Health     Hybrid Journal   (Followers: 1)
DoctorConsult - The Journal. Wissen für Klinik und Praxis     Full-text available via subscription  
Droit, Déontologie & Soin     Full-text available via subscription   (Followers: 3)
E-Health Telecommunication Systems and Networks     Open Access   (Followers: 2)
East and Central African Journal of Surgery     Open Access  
Éducation thérapeutique du patient     Full-text available via subscription   (Followers: 1)
eGEMs     Open Access  
Emergency Radiology     Hybrid Journal   (Followers: 10)
Enfermería Clínica     Full-text available via subscription   (Followers: 3)
Epidemiologic Methods     Hybrid Journal   (Followers: 4)
Ergonomics     Hybrid Journal   (Followers: 24)
Escola Anna Nery     Open Access   (Followers: 1)
Ethnicity & Health     Hybrid Journal   (Followers: 14)
European Journal of Public Health     Hybrid Journal   (Followers: 27)
European Journal of Work and Organizational Psychology     Hybrid Journal   (Followers: 35)
European Research in Telemedicine / La Recherche Européenne en Télémédecine     Full-text available via subscription   (Followers: 2)
Evaluation & the Health Professions     Hybrid Journal   (Followers: 10)
Evidence-Based Nursing     Hybrid Journal   (Followers: 74)
Evolution, Medicine, and Public Health     Open Access   (Followers: 12)
Expert Opinion on Therapeutic Patents     Hybrid Journal   (Followers: 12)
Families, Systems, & Health     Full-text available via subscription   (Followers: 9)
Family Practice Management     Full-text available via subscription   (Followers: 5)
Focus on Health Professional Education : A Multi-disciplinary Journal     Full-text available via subscription   (Followers: 7)
Frontiers in Public Health Services and Systems Research     Open Access   (Followers: 5)
Future Hospital Journal     Full-text available via subscription   (Followers: 2)
Gastrointestinal Nursing     Full-text available via subscription   (Followers: 5)
Geron     Full-text available via subscription  
Global & Regional Health Technology Assessment     Open Access   (Followers: 1)
Global Health Action     Open Access   (Followers: 12)
Global Health Management Journal (GHMJ)     Open Access   (Followers: 1)
Global Health Research and Policy     Open Access   (Followers: 4)
Global Journal of Hospital Administration     Open Access   (Followers: 1)
Global Public Health: An International Journal for Research, Policy and Practice     Hybrid Journal   (Followers: 21)
Globalization and Health     Open Access   (Followers: 9)
Handbook of Practice Management     Hybrid Journal   (Followers: 2)
Health     Open Access   (Followers: 5)
Health & Social Care In the Community     Hybrid Journal   (Followers: 54)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 16)
Health and Interprofessional Practice     Open Access   (Followers: 6)
Health and Technology     Hybrid Journal   (Followers: 4)
Health Care Analysis     Hybrid Journal   (Followers: 17)
Health Care Management Review     Hybrid Journal   (Followers: 16)
Health Economics     Hybrid Journal   (Followers: 59)
Health Expectations     Open Access   (Followers: 16)
Health Facilities Management     Free   (Followers: 10)
Health Informatics Journal     Hybrid Journal   (Followers: 28)
Health Information : Jurnal Penelitian     Open Access   (Followers: 6)
Health Information Science and Systems     Open Access   (Followers: 4)
Health Policy and Management     Open Access   (Followers: 7)
Health Policy and Planning     Hybrid Journal   (Followers: 27)
Health Professions Education     Open Access   (Followers: 3)
Health Promotion International     Hybrid Journal   (Followers: 28)
Health Promotion Practice     Hybrid Journal   (Followers: 18)
Health Psychology     Full-text available via subscription   (Followers: 62)
Health Psychology Review     Hybrid Journal   (Followers: 46)
Health Reform Observer : Observatoire des Réformes de Santé     Open Access   (Followers: 2)
Health Research Policy and Systems     Open Access   (Followers: 16)
Health Science Journal of Indonesia     Open Access   (Followers: 2)
Health Services Research and Managerial Epidemiology     Open Access   (Followers: 3)
Health, Risk & Society     Hybrid Journal   (Followers: 14)
Healthcare : The Journal of Delivery Science and Innovation     Full-text available via subscription   (Followers: 1)
Healthcare Financial Management     Full-text available via subscription   (Followers: 4)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Management Forum     Hybrid Journal   (Followers: 8)
Healthcare Policy / Politiques de Santé     Full-text available via subscription   (Followers: 5)
Healthcare Quarterly     Full-text available via subscription   (Followers: 10)
Healthcare Risk Management     Full-text available via subscription   (Followers: 5)
HealthcarePapers     Full-text available via subscription   (Followers: 2)
Hispanic Health Care International     Full-text available via subscription  
História, Ciências, Saúde - Manguinhos     Open Access   (Followers: 2)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 3)
Hospital     Open Access   (Followers: 3)
Hospital a Domicilio     Open Access  
Hospital Infection Control & Prevention     Full-text available via subscription   (Followers: 15)
Hospital Medicine Clinics     Full-text available via subscription   (Followers: 2)
Hospital Peer Review     Full-text available via subscription   (Followers: 1)
Hospital Pharmacy     Partially Free   (Followers: 18)
Hospital Practice     Hybrid Journal   (Followers: 2)
Hospital Practices and Research     Open Access  
Housing, Care and Support     Hybrid Journal   (Followers: 9)
Human Factors : The Journal of the Human Factors and Ergonomics Society     Full-text available via subscription   (Followers: 39)
Human Resources for Health     Open Access   (Followers: 12)
ICU Director     Hybrid Journal  
Ids Practice Papers     Hybrid Journal  
IEEE Pulse     Hybrid Journal   (Followers: 5)
IISE Transactions on Healthcare Systems Engineering     Hybrid Journal   (Followers: 2)
Independent Nurse     Full-text available via subscription   (Followers: 3)
Index de Enfermeria     Open Access   (Followers: 7)
Indian Journal of Public Health     Open Access   (Followers: 1)
Informatics for Health and Social Care     Hybrid Journal   (Followers: 10)
Innovation and Entrepreneurship in Health     Open Access   (Followers: 1)
INQUIRY : The Journal of Health Care Organization, Provision, and Financing     Open Access   (Followers: 1)
Interface - Comunicação, Saúde, Educação     Open Access   (Followers: 1)
International Archives of Health Sciences     Open Access  
International Journal for Equity in Health     Open Access   (Followers: 9)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 41)
International Journal of Care Coordination     Hybrid Journal   (Followers: 7)
International Journal of Computers in Healthcare     Hybrid Journal   (Followers: 3)
International Journal of Electronic Healthcare     Hybrid Journal   (Followers: 2)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 27)
International Journal of Health Administration and Education Congress (Sanitas Magisterium)     Open Access  
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 15)
International Journal of Health Economics and Management     Hybrid Journal   (Followers: 13)
International Journal of Health Governance     Hybrid Journal   (Followers: 27)
International Journal of Health Planning and Management     Hybrid Journal   (Followers: 6)
International Journal of Health Sciences Education     Open Access   (Followers: 2)
International Journal of Health Services Research and Policy     Open Access   (Followers: 1)
International Journal of Health System and Disaster Management     Open Access   (Followers: 3)
International Journal of Healthcare     Open Access   (Followers: 1)
International Journal of Healthcare Technology and Management     Hybrid Journal   (Followers: 7)
International Journal of Hospital Research     Open Access  
International Journal of Human Factors and Ergonomics     Hybrid Journal   (Followers: 20)
International Journal of Human Rights in Healthcare     Hybrid Journal   (Followers: 5)
International Journal of Medicine and Public Health     Open Access   (Followers: 6)
International Journal of Migration, Health and Social Care     Hybrid Journal   (Followers: 12)
International Journal of Occupational and Environmental Medicine, The     Open Access   (Followers: 15)
International Journal of Palliative Nursing     Full-text available via subscription   (Followers: 32)
International Journal of Positive Behavioural Support     Full-text available via subscription   (Followers: 38)
International Journal of Prisoner Health     Hybrid Journal   (Followers: 14)
International Journal of Privacy and Health Information Management     Full-text available via subscription   (Followers: 3)
International Journal of Public and Private Healthcare Management and Economics     Full-text available via subscription   (Followers: 4)
International Journal of Qualitative Studies on Health and Well-Being     Open Access   (Followers: 22)
International Journal of Reliable and Quality E-Healthcare     Full-text available via subscription   (Followers: 1)
International Journal of Research in Nursing     Open Access   (Followers: 12)
International Journal of Technology Assessment in Health Care     Hybrid Journal   (Followers: 16)
International Journal of Telemedicine and Clinical Practices     Hybrid Journal   (Followers: 5)
International Journal of Telework and Telecommuting Technologies     Full-text available via subscription  
International Journal of Therapy and Rehabilitation     Full-text available via subscription   (Followers: 42)
International Journal of User-Driven Healthcare     Full-text available via subscription   (Followers: 1)
International Journal on Disability and Human Development     Hybrid Journal   (Followers: 23)
Irish Journal of Paramedicine     Open Access   (Followers: 3)
JAAPA     Hybrid Journal   (Followers: 3)
Jaffna Medical Journal     Open Access  
Joint Commission Journal on Quality and Patient Safety     Hybrid Journal   (Followers: 41)
Journal for Healthcare Quality     Hybrid Journal   (Followers: 28)
Journal of Advanced Nursing     Hybrid Journal   (Followers: 250)
Journal of Advances in Medical Education & Professionalism     Open Access   (Followers: 10)

        1 2 | Last

Similar Journals
Journal Cover
Emergency Radiology
Journal Prestige (SJR): 0.412
Citation Impact (citeScore): 1
Number of Followers: 10  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1438-1435 - ISSN (Online) 1070-3004
Published by Springer-Verlag Homepage  [2653 journals]
  • Correction to: Response to letter to the editor, “Neuroradiologic
           Manifestations of COVID-19: What the Emergency Radiologist Needs to
           Know”
    • Abstract: A Correction to this paper has been published: https://doi.org/10.1007/s10140-021-01901-w
      PubDate: 2021-04-01
       
  • Response to letter to the editor, “Neuroradiologic Manifestations of
           COVID-19: What the Emergency Radiologist Needs to Know”
    • PubDate: 2021-04-01
       
  • Correction to: Mediastinal fluid as a predictor for esophageal perforation
           as the cause of pneumomediastinum
    • Abstract: In the original version of this paper contains an error in author name.
      PubDate: 2021-04-01
       
  • What the neuroradiologist should additionally consider in SARS-CoV-2
           infection
    • PubDate: 2021-04-01
       
  • Patients avoided important care during the early weeks of the coronavirus
           pandemic: diverticulitis patients were more likely to present with an
           abscess on CT
    • Abstract: Purpose To evaluate the frequency with which patients with an urgent health concern, specifically diverticulitis, avoided appropriate medical care during the early weeks of the coronavirus pandemic of 2020 and to study the consequences of the resultant delay in care, the incidence of an associated abscess. Methods This study was institutional review board approved. Reports for CT studies with findings of newly diagnosed diverticulitis within Henry Ford Health System during the early weeks of the coronavirus pandemic of 2020 were reviewed and compared with the same time period in 2019. Total cases of diverticulitis on CT were compared, as well as the prevalence of an associated abscess. A chi-squared analysis was performed to determine the statistical significance of the percentage of patients presenting with an abscess in each year. Results During the early weeks of the coronavirus pandemic, 120 patients were identified with CT findings of newly diagnosed diverticulitis with 11.7% of those patients (14 patients) presenting with an associated abscess. During the same time period in 2019, many more CT studies with newly diagnosed diverticulitis were obtained (339), and, compared to 2020, less than half the percentage of those patients had an associated abscess (4.4% or 15 patients). Conclusion Patients with urgent health concerns avoided appropriate and necessary care during the early weeks of the coronavirus pandemic. While non-COVID-19 emergency visits were diminished, patients who did present with diverticulitis were more likely to present with greater disease severity as manifested by an associated abscess. Patients must be encouraged to seek care when appropriate and need reassurance that hospitals and their emergency departments are safe to visit. Furthermore, emergency physicians and radiologists in particular should be vigilant during times when emergency volumes are low, such as a future surge in coronavirus patients, other pandemics, snow storms, and holidays as the patients who do present for care are more likely to present at later stages and with serious complications.
      PubDate: 2021-04-01
       
  • The likely association between wandering spleen and absent left kidney
    • Abstract: Wandering spleen is a cause of acute surgical abdomen with serious consequences. It arises from an absence or weakness of the supporting suspensory splenic ligaments. There is often a delayed diagnosis due to its non-specific clinical presentation. This leads to stalled acquisition of confirmatory diagnostic imaging with resultant increased morbidity and mortality. Congenital or acquired absence of the left kidney results in loss of the splenorenal ligament, a key ligament to maintain normal splenic position in the abdomen. Two patients, one with OHVIRA (obstructed hemivagina ipsilateral renal anomaly) syndrome and another who underwent a left nephrectomy during infancy, developed a wandering spleen with acute splenic torsion in the setting of an absent left kidney. This case series aims to increase awareness to the likely predisposition for individuals with an absent left kidney to develop a wandering spleen.
      PubDate: 2021-04-01
       
  • Comparison of ultrasound-guided versus fluoroscopy-guided reduction of
           forearm fractures in children
    • Abstract: Purpose Point-of-care ultrasound (POCUS) can be used to guide and assess reduction of pediatric forearm fractures. In this study, we sought to compare the success rate of ultrasound-guided fracture reduction with fluoroscopy-guided fracture reduction. We also sought to determine whether there are cost or time benefits to using ultrasound instead of fluoroscopy. Methods The electronic medical records of patients less than 18 years of age presenting to a pediatric emergency department with a forearm fracture between April 2016 and March 2019 were screened for inclusion in this study. A total of 27 ultrasound-guided reductions were identified during this time period and 81 fluoroscopy-guided reductions were randomly selected for comparison. Cost data was provided by the financial department. Reduction success, total length of stay, and costs were compared between the two groups, and multiple linear regression was used to determine the influence of any confounding predictor variables. Results There were no failed reductions in either group. Length of stay was shorter in the POCUS group (221 min) compared with the fluoroscopy group (254 min, p = 0.014), but this significance was lost in the regression model when adjusted for ketamine use. Provider costs ($430 v $442, p = 0.822) and total costs ($1219 v $1204, p = 0.851) were the same between the POCUS group and the fluoroscopy group, respectively. Conclusion POCUS appears to be an equally effective imaging modality to guide reduction of forearm fractures as compared to fluoroscopy.
      PubDate: 2021-04-01
       
  • Negative predictive value of CT for occult fractures of the hip and pelvis
           with imaging follow-up
    • Abstract: Purpose To determine the negative predictive value of multidetector CT for radiographically occult fracture of the hip or pelvis in an elderly population presenting to the emergency department. Methods Two hundred thirty-seven elderly patients with suspected fracture were identified over a 5-year period with negative radiographs acquired in the emergency department followed by an index CT of the hip/pelvis within 24 h. There were 81 cases with a negative index CT, as determined by 2 musculoskeletal radiologists, and with some form of imaging follow-up (MRI, CT, or x-ray) performed within 18 months of the index CT. Follow-up imaging was reviewed by 2 musculoskeletal radiologists for the presence of fracture to determine the performance of the index CT. The electronic medical record was used to exclude the possibility of intervening trauma between the time of the index CT and follow-up imaging. Results There were 39 cases with follow-up imaging performed within 6 weeks of the negative index CT, and 42 with follow-up imaging within 6 weeks to 18 months of the negative index CT. Eight of 81 patients demonstrated a fracture on follow-up imaging, with 3 of 8 involving the femoral neck or intertrochanteric femur. The negative predictive value of the index CT for the detection of a radiographically occult hip or pelvic fracture was 90.1%. If considering only surgically relevant fractures (femoral neck and intertrochanteric fractures), the negative predictive value improved to 96.3%. Conclusion Computed tomography for occult hip fractures has a high negative predictive value but there are cases not detected with surgical implications.
      PubDate: 2021-04-01
       
  • Imaging evaluation of traumatic carpal instability
    • Abstract: Purpose To review the epidemiology, pertinent wrist anatomy, classification system, and emergent imaging evaluation of carpal instability with a focus on radiographic assessment of instability. Methods A review of current literature on carpal instability was performed with summary presentation of carpal instability epidemiology, carpal anatomy, imaging evaluation, and classification with imaging evaluation focused on diagnosis in the emergency setting. Results Carpal instability is a common pathology in falls on outstretched hand and is likely underdiagnosed due to instability being occult or demonstrating subtle malalignment on static imaging of the wrist. While there is a complex network of intrinsic and extrinsic ligaments contributing to carpal instability, a detailed knowledge of these ligaments is not necessary for radiologists to make an accurate diagnosis in the emergency setting, as identification and classification of carpal instability is based on identification of carpal malalignment patterns on radiography as opposed to identification of specific ligament injuries on advanced imaging. The Mayo classification is the most widely used classification system, which divides carpal instability into four categories: dissociative, non-dissociative, complex, and adaptive. Understanding this classification system allows radiologists to successfully classify almost all carpal instability injuries they will encounter, even in the setting of unusual or rare instability patterns. Conclusion In working with the treating clinician, it is essential that the emergency radiologist is comfortable with identifying and classifying carpal instability. This will ensure prompt treatment of seemingly benign injuries and those that require intervention, surgical or otherwise, improving the likelihood of a good outcome.
      PubDate: 2021-04-01
       
  • Diagnostic yield of computed tomographic pulmonary angiography for
           suspected pulmonary embolism varies across settings within a
           community-based health system
    • Abstract: Purpose The diagnostic yield of computed tomographic pulmonary angiography (CTPA) for pulmonary embolism varies in the literature, and very little data is available regarding community-based systems. This study evaluates the yield of CTPA for pulmonary embolism across a variety of patient care settings in a community-based healthcare system, providing relevant benchmarks for potential quality improvement efforts. Methods This retrospective study included data collected from three sites within a single community-based healthcare system, including a tertiary care level 1 trauma center, an urban community hospital, and a suburban free-standing emergency department. CTPAs were identified by Current Procedural Terminology codes, and diagnoses of pulmonary embolism were identified via International Classification of Diseases codes. A total of 7850 CTPA studies met criteria for inclusion between January 1, 2012, and October 8, 2014. Results Pulmonary embolism was found in 884 (11.3%) of the studies performed. Outpatients had a lower yield of pulmonary embolism (3.8%, p < 0.001) compared with inpatients (14.1%) and emergency department patients (10.7%, p < 0.001). Patients with diagnoses of deep vein thrombosis or neoplasm had increased incidence of pulmonary embolism when compared with patients without these diagnoses (p < 0.001 for both). Conclusion The overall yield of CTPA for pulmonary embolism in this community-based system was similar to that at academic centers. The yield was significantly lower in the outpatient setting compared with studies originating in the emergency department or inpatient setting.
      PubDate: 2021-04-01
       
  • Mediastinal fluid as a predictor for esophageal perforation as the cause
           of pneumomediastinum
    • Abstract: Purpose Pneumomediastinum is not an uncommon finding on emergency CTs and is seen in a variety of settings, including acute trauma, recent repeated emesis and recent thoracic surgery, and after EGD (Kouritas et al. J Thorac Dis 7(Suppl 1):S44–S49, 2015). The purpose of this study was to examine cases of CT pneumomediastinum for distinguishing features which could support or exclude esophageal injury as a cause, which in turn could help guide evaluation of these patients. Methods CT chest scans showing pneumomediastinum performed in the emergency department between January 2013 and December 2018 were included. The presence or absence of fluid within the mediastinal compartments was correlated with esophageal perforation and subdivided into the clinical scenarios of trauma, suspected Boerhaave’s syndrome, recent surgery or EGD, and other. Accuracy of this finding was compared with fluoroscopic esophagography. Results Twenty-two cases of esophageal perforation were identified out of a total of 324 included cases. The cases were subdivided into four categories: trauma, suspected Boerhaave syndrome, suspected iatrogenic perforation from recent procedure or surgery, and other. Two hundred fourteen cases of pneumomediastinum occurred in the setting of trauma, and 2 had esophageal perforation. Both showed mediastinal fluid. Twenty-two cases had mediastinal fluid without perforation. Seventeen cases of pneumomediastinum occurred in the setting of suspected Boerhaaves, and 3 had esophageal perforation. Every case with esophageal perforation had mediastinal fluid, and every case without perforation had no mediastinal fluid. Nine cases of pneumomediastinum occurred in the setting of suspected iatrogenic perforation after recent surgery or procedure. Six cases had esophageal perforation, and 5 of these had mediastinal fluid. All three cases without perforation also had mediastinal fluid. Eighty-six cases were classified as other and included a variety of clinical histories. This category contained 8 esophageal perforations, 7 of which had mediastinal fluid. One case of mediastinal fluid was not associated with esophageal perforation in this category. Conclusion The presence of mediastinal fluid, specifically within the visceral compartment, strongly suggests esophageal injury, and its absence strongly argues against it. An important caveat is in the setting of recent surgery, in which mediastinal fluid can be seen normally. An esophagography study can supplement the evaluation if there is a discrepancy between the clinical suspicion and the original CT findings.
      PubDate: 2021-04-01
       
  • Overuse of brain CT scan for evaluating mild head trauma in adults
    • Abstract: Introduction CT scan is crucial in evaluating head trauma. However, its inappropriate use will cause unnecessary radiation exposure to patient and financial burden to health systems. Our aim is appraising amount of brain CT scans performed in our Emergency Department (ED) for evaluating mild head trauma which are not indicated according to four standardized guidelines as well as analyzing contributing factors. Methods This was a descriptive prospective study. We included randomly selected adult patients under 75 years old with minor head trauma evaluated by brain CT scan at our ED. For all patients, we completed a checklist including demographic data, mechanism of trauma, specialty of the requesting physician, and whether the patient meets the brain CT guidelines criteria. Brain CT overuse was defined as scans performed for patients without criteria of any of the standardized guidelines. Results We evaluated 170 patients. The mean age of patients was 38.38 ± 19.73 years old. The most common mechanism of trauma was falling (37.6%). The overall brain CT scan overuse was 15.3%. Most of the overused scans were performed in younger patients, and patient’s age was inversely correlated to overuse. There was no significant difference based on the mechanism of trauma and the specialty of requesting physician. Discussion Our study accentuates the high frequency of brain CT scan overuse, leading to unnecessary radiation exposure and financial burden on healthcare systems. We emphasize that using a guideline for requesting brain CT scan can eliminate unnecessary scans along with detecting patients with important decisive damages.
      PubDate: 2021-04-01
       
  • Assessment of final-year medical students’ performance in diagnosing
           critical findings on chest X-ray
    • Abstract: Purpose Due to the recently emerging shortage in medical staff during the novel corona virus pandemic, several countries have rushed their undergraduate medical students into the emergency department. The accuracy of diagnosing critical findings on X-rays by senior medical students is not well assessed. In this study, we aim to assess the knowledge and accuracy of undergraduate final-year medical students in diagnosing life-threatening emergency conditions on chest x-ray. Method This is a cross-sectional nationwide survey across all medical schools in Jordan. Through an electronic questionnaire, participants were sequentially shown a total of six abnormal X-rays and one normal. For each X-ray, participants were asked to choose the most likely diagnosis, and to grade the degree of self-confidence regarding the accuracy of their answer in a score from 0 (not confident) to 10 (very confident). Results We included a total of 530 participants. All participants answered at least six out of seven questions correctly, out of them, 139 (26.2%) participants answered all questions correctly. Pneumoperitoneum was the highest correct answer (93.8%), whereas flail chest was the least correctly answered case with only 310 (58.5%) correct answers. Regarding self-confidence for each question, 338 participants (63.8%) reported very high overall self-confidence level. Answers related to tension pneumothorax had the highest confidence level. Conclusion Senior Jordanian medical students showed good knowledge with high confidence levels in diagnosing life-threatening conditions on chest x-rays, supporting their incorporation in the emergency department during pandemics and confirming the reliability of information they can extract.
      PubDate: 2021-04-01
       
  • Incidence and characteristics of spinal injuries in the victims of
           intimate partner violence (IPV)
    • Abstract: Purpose To describe the incidence and patterns of the spinal injuries in the victims of physical IPV. Materials and methods With institutional review board (IRB) approval, we retrospectively reviewed patients referred to our institution’s domestic violence intervention and prevention program with a diagnosis directly related to physical abuse between January 2013 and June 2018. Electronic health records and radiology reports were reviewed for all patients. Results A total of 21/688 (3%) IPV patients with 41 vertebral injuries were identified. The study population comprised of 19/21 (90%) females. Median age of the included patients was 43 years with a range of 21–72 years. All vertebral injuries were AO type A spinal injuries. Upper lumbar spine (L1 and L2) was the most common level of injury followed by upper to mid-thoracic spine. The reported mechanism of the injury was IPV in 8/21 (38.0%), fall in 8/21(38.0%), and incidental in 5/21 (24.0%). Ten out of 21 (48%) patients had concomitant injuries, most commonly to the craniofacial region 5/21 (23%). Psychiatry history was positive in 17/21 (81%), and substance abuse was positive in 15/21 (71%) of the patients. Conclusion Incidence of spinal injuries is relatively low in IPV with morphologic AO type A injury being the most common type of injury and the upper lumbar spine being the most common level of injury.
      PubDate: 2021-04-01
       
  • Thromboembolic complications of COVID-19
    • Abstract: The symptomology of patients afflicted with novel 2019 coronavirus disease (SARS-CoV-2 or COVID-19) has varied greatly, ranging from the asymptomatic state to debilitating hypoxemic respiratory failure caused by severe atypical viral pneumonia. Patients may also develop a hyper-inflammatory state that can lead to multi-organ failure. It has become increasingly apparent that, as part of the hyper-inflammatory state, COVID-19 infection increases susceptibility to systemic thromboembolic complications that can contribute to rapid clinical deterioration or demise. This article aims to review imaging features of various systemic thrombotic complications in six patients with moderate to severe disease. This case series includes examples of pulmonary embolism, stroke, right ventricular thrombosis, renal vein thrombosis, and aortic thrombosis with leg ischemia.
      PubDate: 2021-04-01
       
  • Gut wrenching: cases of missed gastrointestinal tumors and their mimics on
           computed tomography
    • Abstract: Computed tomography (CT) of the abdomen and pelvis is one of the most common imaging studies ordered through the emergency department (ED). Because these studies are ordered for the detection of acute abnormalities and due to the relatively low incidence in patients presenting through the ED, gastrointestinal tumors are commonly missed. Moreover, many CT findings of malignant tumors overlap with benign entities, which can present a diagnostic challenge. This review article will describe the common CT findings of gastric, small bowel, colon, and appendiceal cancer as well as some of the common benign gastrointestinal conditions with similar imaging findings.
      PubDate: 2021-04-01
       
  • The effect of COVID-19 on emergency department imaging: what can we
           learn'
    • Abstract: Purpose To investigate the effect of the COVID-19 pandemic on emergency department (ED) imaging. Methods This retrospective study included all ED visits at a four-hospital academic health system in two matched 5-week periods. Demographic information, COVID-19 status, and disposition were reviewed. Type of imaging, acquisition time, and radiology reports were analyzed. Significance level was set at p < 0.05. Results A 43.2% decrease in ED visits and 12% reduction in overall ED imaging occurred during the pandemic period. Mean age was unchanged, but a shift in gender and racial characteristics was observed (p < 0.001). In the pandemic period, COVID-19 ED patients were older (61.8 ± 16.9 years, p < 0.001) and more likely to be Black (64.2%; p < 0.001) than non-COVID-19 patients. Imaging per ED encounter increased to 2.4 ± 2.8 exams from 1.7 ± 1.1 (p < 0.001). Radiography increased (57.2% vs. 52.4%) as a fraction of total ED imaging, while computed tomography (23.4% vs. 27.2%) and ultrasound (8.5% vs. 9.6%) decreased (pre-pandemic vs. pandemic). COVID-19 ED patients underwent CT and US at a lower rate (11.5% and 5.4%) than non-COVID-19 patients (25.4% and 9.1%). The proportion of imaging study reports concluding “no disease” or “no acute disease” decreased from 56.7 to 40.6% (p < 0.001). Conclusion The COVID-19 pandemic led to a significant reduction in ED visits, a shift in patient demographics, and a significant decrease in imaging volume. Additional impact included a significant increase in the proportion of positive imaging studies.
      PubDate: 2021-04-01
       
  • Point-of-care ultrasound assessment of the abdominal aorta by physician
           assistant students: a pilot study
    • Abstract: Objective Point-of-care ultrasound (POCUS) decreases time to diagnosis and improves mortality of those diagnosed with abdominal aortic aneurysms and dissections. While medical students have demonstrated an ability to obtain adequate POCUS images of the abdominal aorta (AA), physician assistant (PA) student studies are lacking. This pilot study aims to evaluate the ability of PA students to acquire AA POCUS images. Methods PA students, instructors, and models voluntarily participated. Student participants received online material to review several weeks before the study. During the study, students performed 4 precepted practice scans of the AA, and their fifth scan was recorded for review by three ultrasound fellowship trained Emergency Medicine physicians. Images were graded on proper identification and measurement of the AA, as well as interpretability of images. Results A total of 20 PA students participated. Ninety-five percent were able to obtain interpretable transverse images of the distal aorta and longitudinal views of the aorta, and 65% were able to obtain interpretable transverse images of the proximal and mid aorta. Conclusions In the most rigorous evaluation of student-obtained AA POCUS images to date, we found that PA students were able to obtain adequate AA images. PA students were able to image the distal and longitudinal aorta in the transverse plane where the majority of AAAs are found to a very high degree. Results demonstrate PA students’ ability to learn POCUS and encourage PA education to take steps to incorporate POCUS education and development of competency standards for PA graduates.
      PubDate: 2021-04-01
       
  • Conditional unnecessity of head CT for whole-body CT of traffic accident
           victims: a pilot study
    • Abstract: Purpose To investigate whether head CT should be included in whole-body CT in road traffic accident victims. Methods A review of electronic medical records identified 124 patients (81 males, 43 females; age 4 to 92 years, mean 47.7 years) involved in a road traffic accident in a 12-month period. All had undergone whole-body CT and physical and neurologic examinations. We recorded their age, sex, Glasgow Coma Scale (GCS), systolic blood pressure (SBP), the type of traffic accident, and the presence/absence of visible trauma above the clavicles (VTCs) and of acute traumatic brain injury (TBI) on CT. Statistical analyses were performed to evaluate predictors of acute TBI. Results Of 124 patients, 34 (27%) manifested acute TBI on CT. Univariate analysis identified their age, GCS, SBP, VTCs, and the accident type as statistically significant factors for acute TBI (p < 0.05). Multivariate analysis demonstrated VTCs, GCS score < 15, and SBP ≤ 90 mmHg were significant independent predictors of acute TBI (p = 0.001, p = 0.001, and p = 0.004, respectively); the odds ratio was 16.07 for VTCs, 14.85 for GCS score < 15, and 13.78 for SBP ≤ 90 mmHg. No patients without both decrease in GCS score and VTCs manifested acute TBI. Conclusion Our pilot study showed that visible trauma above the clavicles and decrease in GCS score were highly associated with the presence of acute TBI in road traffic accident victims. In whole-body CT, a head CT may not be indicated in patients without these factors.
      PubDate: 2021-04-01
       
  • Clinical utility of a focused hip MRI for assessing suspected hip fracture
           in the emergency department
    • Abstract: Purpose A focused hip MRI (FHMR) for the detection of radiographically occult hip fractures was implemented in our emergency department (ED) in 2013. The goal of this study was to assess the clinical utility of this protocol. Methods We retrospectively reviewed radiology reports of 262 unique patients who underwent 263 FHMR (coronal T1, coronal STIR, axial T2 fat saturated) for suspected hip fracture in the ED from October 2013 to March 2020. Electronic medical records were reviewed for the ED course, follow-up imaging, and clinical management within 90 days. Results Seventy-one patients had one or more fractures identified by FHMR: one-third had proximal femoral fractures; two-third had pelvic fractures. Of these 71 patients, 53 (74%) had radiographically occult fractures, including 14 (20%) with occult proximal femoral fractures; 4 patients had fractures occult on CT. Nineteen patients with a suspected fracture on radiography were found to have no fracture on FHMR. Four fractures not reported on FHMR were later seen on follow-up imaging: these included 1 isolated greater trochanter, 1 additional ischial tuberosity, 1 additional superior pubic ramus, and 1 additional sacrum. All four fractures were treated non-operatively. Muscle/tendon injury was the most common type of injury, seen in 50% (130/262) patients with the most commonly torn tendons being the hamstring (44%; 15/34) followed by gluteus medius tendon (18%; 6/34). A full-hip or pelvis MRI was done after FHMR in only 5 patients, primarily for the purpose of better characterizing findings already identified on FHMR (2 for fracture, 2 for tendon injury, 1 for soft tissue metastasis). Only one of these five studies provided new information: ruling out a previously questioned fracture. Clinical management of the vast majority of patients was based solely on findings from the FHMR. Conclusions FHMR offers reliable identification of radiographically occult hip fractures and muscle/tendon injuries. The protocol is well trusted in guiding patient management in our ED.
      PubDate: 2021-04-01
       
 
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