Establishment and implementation of an effective rule for the interpretation of computed tomography scans by emergency physicians in blunt trauma

INTRODUCTION: Computed tomography (CT) can detect subtle organ injury and is applicable to many body regions. However, its interpretation requires significant skill. In our hospital, emergency physicians (EPs) must interpret emergency CT scans and formulate a plan for managing most trauma cases. CT misinterpretation should be avoided, but we were initially unable to completely accomplish this. In this study, we proposed and implemented a precautionary rule for our EPs to prevent misinterpretation of CT scans in blunt trauma cases. METHODS: We established a simple precautionary rule, which advises EPs to interpret CT scans with particular care when a complicated injury is suspected per the following criteria: 1) unstable physiological condition; 2) suspicion of injuries in multiple regions of the body (e.g., brain injury plus abdominal injury); 3) high energy injury mechanism; and 4) requirement for rapid movement to other rooms for invasive treatment. If a patient meets at least one of these criteria, the EP should exercise the precautions laid out in our newly established rule when interpreting the CT scan. Additionally, our rule specifies that the EP should request real-time interpretation by a radiologist in difficult cases. We compared the accuracy of EPs’ interpretations and resulting patient outcomes in blunt trauma cases before (January 2011, June 2012) and after (July 2012, January 2013) introduction of the rule to evaluate its efficacy. RESULTS: Before the rule’s introduction, emergency CT was performed 1606 times for 365 patients. We identified 44 cases (2.7%) of minor misinterpretation and 40 (2.5%) of major misinterpretation. After introduction, CT was performed 820 times for 177 patients. We identified 10 cases (1.2%) of minor misinterpretation and two (0.2%) of major misinterpretation. Real-time support by a radiologist was requested 104 times (12.7% of all cases) and was effective in preventing misinterpretation in every case. Our rule decreased both minor and major misinterpretations in a statistically significant manner. In particular, it conspicuously decreased major misinterpretations. CONCLUSION: Our rule was easy to practice and effective in preventing EPs from missing major organ injuries. We would like to propose further large-scale multi-center trials to corroborate these results

98℃における、加熱凝固した卵白中のNaClの二元収着拡散 : 速報

The concentration profile of NaCl by the one dimensional diffusion with the FRITRUC method in pre-cooked egg white from the 3.0% solution was measured at 98℃. Fick\u27s diffusion coefficient, D, calculated therefrom was 2-4 × 10^cm^2s^ and showed a maximum near 0.07mol kg^-1. This variation was quantitatively interpreted by applying the dual mode sorption and diffusion theory developed for the dyeing of Nylon with some anionic dyes. Two thermodynamic diffusion coefficients, D_T(p) and D_T(L), where p and L means partition and Langmuir mode species of NaCl, respectively, a parameter, a, derived from the equilibrium relations between the p and L species, and S, the concentration of the Langmuir adsorption site in the egg white, were estimated. D_T(p) was found to be 2.2 × 10^cm^2s^ and D_T(L) was 2.5 × 10^cm^2s^. These results were discussed with reference to the NaCl diffusion in Japanese radish