Waqas Shuaib1, Mariyam Hashmi2, Arvind Vijayasarathi3, Jay Arunkumar4, Sabeen Tiwana5, Faisal Khosa3. 1. Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia, USA waqas.shuaib@emory.edu. 2. Dow International Medical College, DUHS, Karachi, Pakistan. 3. Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia, USA. 4. University of Mississippi Medical Center, Jackson, Mississippi, USA. 5. Midtown Dental Practice, Atlanta, Georgia, USA.
Abstract
INTRODUCTION: Facial computed tomography (CT) is often performed in the emergency department as a part of the diagnostic workup for patients presenting with the signs and symptoms of dentoalveolar abscess (DA). This investigation evaluated the diagnostic yield of the facial CT and its effects on management change in patients suspected of DA. Furthermore, we assessed secondary consequences of routine facial CT use in this population by using turn-around time (TAT), cost, and radiation exposure as the key parameters. MATERIAL AND METHODS: We retrospectively reviewed records of suspected DA patients over a 5-year period, from June 2008 to June 2013. TAT was calculated for patients from the time the examination was ordered by the emergency department physician, to the time the report was finalized by the attending radiologist. Effective radiation dose for facial CT was calculated by multiplying dose length product by the standard conversion coefficient K (K = 0.0021 mSv/mGy x cm). CT cost was included for reference but was not analyzed extensively due to the lack of standardization of costs across the various institutions. RESULTS: Our investigation consisted of 117 patients; 75 males of average age 41 (±12) years and 42 females of average age 44 (±17) years. Out of the total 117 patients that underwent CT for the suspicion of a simple DA, only a single individual (0.85%) underwent a management change. Mean TAT of facial CT was 110 (±63) minutes, and a median TAT was 87 (±71) minutes. Average effective radiation dose for a facial CT was 2.4 (±0.4) mSv. Approximate estimated cost of a contrast enhanced facial CT was $253 and non-contrast facial CT was $209. CONCLUSION: Our study shows that routine use of facial CT has a very limited diagnostic value in the workup of simple DA and rarely results in management change. The overall impact on patient management is miniscule in the context of prolonged TAT, radiation exposure, and adding to the rising medical costs.
INTRODUCTION: Facial computed tomography (CT) is often performed in the emergency department as a part of the diagnostic workup for patients presenting with the signs and symptoms of dentoalveolar abscess (DA). This investigation evaluated the diagnostic yield of the facial CT and its effects on management change in patients suspected of DA. Furthermore, we assessed secondary consequences of routine facial CT use in this population by using turn-around time (TAT), cost, and radiation exposure as the key parameters. MATERIAL AND METHODS: We retrospectively reviewed records of suspected DA patients over a 5-year period, from June 2008 to June 2013. TAT was calculated for patients from the time the examination was ordered by the emergency department physician, to the time the report was finalized by the attending radiologist. Effective radiation dose for facial CT was calculated by multiplying dose length product by the standard conversion coefficient K (K = 0.0021 mSv/mGy x cm). CT cost was included for reference but was not analyzed extensively due to the lack of standardization of costs across the various institutions. RESULTS: Our investigation consisted of 117 patients; 75 males of average age 41 (±12) years and 42 females of average age 44 (±17) years. Out of the total 117 patients that underwent CT for the suspicion of a simple DA, only a single individual (0.85%) underwent a management change. Mean TAT of facial CT was 110 (±63) minutes, and a median TAT was 87 (±71) minutes. Average effective radiation dose for a facial CT was 2.4 (±0.4) mSv. Approximate estimated cost of a contrast enhanced facial CT was $253 and non-contrast facial CT was $209. CONCLUSION: Our study shows that routine use of facial CT has a very limited diagnostic value in the workup of simple DA and rarely results in management change. The overall impact on patient management is miniscule in the context of prolonged TAT, radiation exposure, and adding to the rising medical costs.
Authors: Scott T Wilber; Lowell W Gerson; Kevin M Terrell; Christopher R Carpenter; Manish N Shah; Kennon Heard; Ula Hwang Journal: Acad Emerg Med Date: 2006-10-27 Impact factor: 3.451
Authors: Diana L Miglioretti; Eric Johnson; Andrew Williams; Robert T Greenlee; Sheila Weinmann; Leif I Solberg; Heather Spencer Feigelson; Douglas Roblin; Michael J Flynn; Nicholas Vanneman; Rebecca Smith-Bindman Journal: JAMA Pediatr Date: 2013-08-01 Impact factor: 16.193