[Selection protocol for the realization of roentgen studies in patients with injuries to the extremities].
Explore the source record for details and available documents.
Arm Injuries↗
Biomedical subjects
M D Ecker
Publications and source records attributed to M D Ecker.
A protocol for selecting patients with injured extremities who need x-rays.
To help curb excessive radiography, we developed a protocol for selecting patients with injured extremities who need x-ray examination, and we tested the protocol prospectively in 848 patients to determine its safety and effectiveness. Strict adherence to the protocol would have reduced x-ray usage by 12 per cent for upper extremities and 19 per cent for lower extremities. The actual reductions were 5 per cent and 16 per cent, respectively, since further reductions were limited by patient's demands for x-ray examinations. One fracture in 287 were missed, but the treatment was appropriate and the outcome satisfactory. By eliminating superfluous x-ray procedures, the protocol could reduce charges by $79 million to $139 million nationwide, without compromising quality of care or increasing malpractice liability. Nevertheless, even the best protocol cannot eliminate all negative x-ray studies. These results should serve as a stimulus for judicious use of radiography, but also as a warning to avoid overzealous cost-containment strategies that would reduce x-ray usage to below a safe threshold.
Connecticut↗
Benign pneumoperitoneum after fiberoptic colonoscopy. A prospective study of 100 patients.
A prospective study of 100 consecutive unselected patients undergoing both diagnostic and therapeutic firoptic colonoscopy was undertaken. Our incidence of colonic perforation is 1%, which is similar to the incidence reported in the literature. This study suggests that even when immediate postcolonoscopic supine and erect abdominal radiographs as well as pre- and postcolonoscopic total blood counts and enzyme levels to supplement clinical impressions are obtained, the incidence of perforation of the colon after fiberoptic colonoscopy is low and not any higher than that reported in the literature. Pneumoperitoneum may occur after fiberoptic colonoscopy with minimal or no clinical evidence suggesting perforation. Perforation in some patients may be treated conservatively without the need of emergency laparotomy.
Adult↗