CT scans gained popularity in all of the most common ER complaints, including symptoms where it's unclear what extra information a scan can provide, researchers said.
In some instances, a well-timed scan can help doctors make an important diagnosis and can save money by determining which patients don't need to stay in the hospital for observation, Dr. Keith Kocher of the University of Michigan in Ann Arbor and colleagues write in Annals of Emergency Medicine.
But another recent study found that doctors rely much more on patient history and a physical exam than the results of CTs done in the ER when making a diagnosis (see Reuters Health story of August 12, 2011.)
The scans also come with a small dose of radiation that's been linked to slightly increased cancer risks many years down the line, and have a price tag of a few hundred dollars each.
"You can't keep increasing your rate of scanning the way we are," Kocher told Reuters Health. "Eventually you're just going to be scanning everybody, and that doesn't make any sense."
"We are definitely doing too many," he added.
Kocher's team used a representative sample of about 370,000 trips to ERs across the U.S. between 1996 and 2007. For each visit, they had information on patients' primary complaint, whether or not they were given a CT scan in the ER, and if they were ultimately admitted to the hospital for further treatment or observation.
In 1996, just over three percent of all trips to the ER included a CT scan.
By 2007, that figure had risen to almost 14 percent, which is about a quarter of the 72 million scans done in the U.S., according to the researchers.
Scans became more common for ER patients with all 20 of the most common complaints, and increased the fastest for stomach, side, and chest pains.
For side pain, those CTs are probably not necessary most of the time, Kocher said. In those cases, doctors are typically looking for a kidney stone to show up on the scan.
"Whether or not you diagnose a kidney stone on a CT scan (or another way, with an ultrasound or just using patient symptoms), it kind of doesn't matter, because ultimately most of the patients are sent home," Kocher said.
In that case, "You have to wonder if the CT scan is getting us any additional worthwhile information."
The new findings bolster earlier work pointing to a rapid growth in new imaging technology.
Kocher said it's hard to make a general rule about when a CT scan is or isn't necessary, because specific details of each case come into play.
Over the course of the study, fewer patients were admitted to the hospital after getting a CT scan. That could mean that the tests helped doctors rule out serious conditions and avoid keeping patients in the hospital, but the study can't prove the two are definitely linked, Kocher said.
2011年8月25日星期四
2011年7月17日星期日
Matt Harrison finding consistency
He's dealt with a blister, an annoying kidney stone that took 10 days to pass and a triceps bruise. But Matt Harrison's biggest challenge was staying away from the big inning and becoming a consistent starter in the Rangers rotation.
He's doing it. Harrison is 5-3 with a 1.94 ERA in his last 10 starts. He has quality starts in all but two of them and is averaging nearly 6 2/3 innings in that span. Harrison's latest success story was Sunday in Seattle, when he held the Mariners to five hits and one run in 7 2/3 innings, earning the victory. It was the Rangers' 11th straight win and puts them four games up in the AL West.
"I think I'm stronger mentally," said Harrison, who was reading pitching psychology books in spring training. "I'm not letting the big inning happen and I'm executing. I take time in between batters to focus."
Harrison's sinker was working for him Sunday. He said he was able to throw it in any count and know he could get a strike or a ground ball. And he got plenty of those. He had 14 outs that were ground balls or strikeouts, with his biggest coming to his final batter.
After the Mariners had scored their first run of the game in the eighth inning on a Jack Wilson single, Harrison faced Ichiro Suzuki as the tying run.
"If I put him on, there's no telling what happens there," Harrison said.
The 25-year-old lefty got ahead in the count 0-2 on fastballs and then threw a nasty changeup that had plenty of break.
"It was a pitch he hadn't seen before in the previous at-bats," Harrison said. "I was able to speed him up with fastballs before that."
The strikeout allowed Mark Lowe to enter the game with one on and two outs against right-handed hitting Franklin Gutierrez, who grounded out to end the inning. Neftali Feliz came on and did what he always does against the Mariners: no-hit them. Seattle is 0-for-33 with 13 Ks and two walks against Feliz for his career.
"He kept us in the ballgame, got us deep in the ballgame," manager Ron Washington said of Harrison. "He's stayed away from the big inning, pounded the strike zone, not staying in one part of the plate and working fast. All of that comes into play."
Harrison was pleased with his rhythm and has made an effort to be quick, but not too quick. He's found a happy medium between the guy with the super-fast windup last year and the one who works fast, but more calmly on the mound. The result is a starter gaining confidence with each start.
He's doing it. Harrison is 5-3 with a 1.94 ERA in his last 10 starts. He has quality starts in all but two of them and is averaging nearly 6 2/3 innings in that span. Harrison's latest success story was Sunday in Seattle, when he held the Mariners to five hits and one run in 7 2/3 innings, earning the victory. It was the Rangers' 11th straight win and puts them four games up in the AL West.
"I think I'm stronger mentally," said Harrison, who was reading pitching psychology books in spring training. "I'm not letting the big inning happen and I'm executing. I take time in between batters to focus."
Harrison's sinker was working for him Sunday. He said he was able to throw it in any count and know he could get a strike or a ground ball. And he got plenty of those. He had 14 outs that were ground balls or strikeouts, with his biggest coming to his final batter.
After the Mariners had scored their first run of the game in the eighth inning on a Jack Wilson single, Harrison faced Ichiro Suzuki as the tying run.
"If I put him on, there's no telling what happens there," Harrison said.
The 25-year-old lefty got ahead in the count 0-2 on fastballs and then threw a nasty changeup that had plenty of break.
"It was a pitch he hadn't seen before in the previous at-bats," Harrison said. "I was able to speed him up with fastballs before that."
The strikeout allowed Mark Lowe to enter the game with one on and two outs against right-handed hitting Franklin Gutierrez, who grounded out to end the inning. Neftali Feliz came on and did what he always does against the Mariners: no-hit them. Seattle is 0-for-33 with 13 Ks and two walks against Feliz for his career.
"He kept us in the ballgame, got us deep in the ballgame," manager Ron Washington said of Harrison. "He's stayed away from the big inning, pounded the strike zone, not staying in one part of the plate and working fast. All of that comes into play."
Harrison was pleased with his rhythm and has made an effort to be quick, but not too quick. He's found a happy medium between the guy with the super-fast windup last year and the one who works fast, but more calmly on the mound. The result is a starter gaining confidence with each start.
2011年6月8日星期三
Against doctor's orders
Justin Melton woke up urinating blood.
It was May 14, a Saturday. It was the second and final day of the 3A East Regional Track Meet. Melton was scheduled to compete in four different events. He won them all.
Tuesday is when the pain came. It was a sharp, stabbing pain that came out of his lower back and extended all across his midsection. It was the worst pain of his life for a kid whose suffered torn ligaments and broken bones on the football field.
Still in agony, Melton went to the emergency room on Wednesday morning.
After checking for a wide range of culprits like an appendicitis, the hospital took a CT scan and saw a kidney stone about the size of a pencil eraser. They gave him some pain pills to help while he was trying to pass it, but the pain made him so nauseous that he couldn’t keep them, or the food he was supposed to take them with, down. Doctors prescribed him a drug called Dilaudid to be given through IVs, which Melton said was several times stronger than morphine.
“I don’t know what happened, man,” Melton said. “Someone above was looking out for me because Thursday morning, I woke up and they were going to send me to Cheyenne for surgery to get the stone removed because it was blocking my urine from leaving my kidney and my kidney was swelling up.”
Before leaving to drive south on I-25 to Cheyenne, Melton called track coach Wes Gamble to let him know he wasn’t going to make it to the state meet in Casper. Gamble told Melton not to worry about it. His health comes first. On the side though, the two, along with the rest of the Bearcat squad, knew they couldn’t win a state championship without Melton.
“I hung up the phone with him and I could tell that he was about in tears, but I hung up the phone and sat there for a minute and beat the hell out of my bed in the hospital and got my knuckles all bloody,” Melton said. “I stood up, ripped the IVs out of my arm and said, ‘Mom, Dad, we are going to Casper.’”
Melton’s mom, Junan, took some convincing. She was concerned about him rupturing a kidney or worse during the state meet, where Melton was expected to compete in the long jump, 100-meter, 200-meter and 400-meter dashes over the next three days. His dad, Rusell, sided with his son. It was the last track meet of his high school career. If he could tolerate the pain, then go for it. Over the next 15 minutes, they talked mom into rolling the dice and drove west instead of south.
Junan texted Gamble’s wife right away, telling her to tell him not to scratch Melton from his races. If Gamble had already told the officials to replace Melton, there was no going back on it. She reached him as he was talking to the officials, but before he told them to scratch Melton.
“I’m just glad that didn’t happen. Someone was looking out for me,” Melton said.
The long jump was scheduled for 11 a.m. As Melton walked toward his teammates at Kelly Walsh High School, the wind was howling on the wrong side of freezing. Snow was falling. Melton’s face was almost as pale as the white flakes. His pupils were dilated. His head was loopy from all the painkillers still clinging to so many of his nerve endings.
“What are you doing here?” A stunned Gamble asked.
“I’m long jumping, coach,” Melton answered.
“Alright. We’ll see how you feel when you’re running down the runway,” Gamble said.
Running in the 200-meter dash prelims wasn’t very painful, but the sudden stopping and the hard landings of the long jump hurt. His swollen kidneys throbbed with each heavy step.
“You know what it’s like jumping up and down on a full stomach? Imagine that times 20,” Melton said.
After the long jump and 200-meter dash, Melton went to see a specialist in Casper. The doctor told him the intense pain on Tuesday and Wednesday was when the kidney stone was passing through three small passages in the ureter, which connects the kidneys to the bladder. He most likely got the kidney stone in the first place from being dehydrated. It has always been a bad habit. He never takes drinks with him on the bus, forgets to drink water during meets, and the team doesn’t stop for dinner on the way home.
“‘I’ll probably never get dehydrated again,” Melton said.
Friday, he felt a little better and by Saturday he was feeling great for the finals. He won three out of four events and broke his own 3A state record in the 100-meter dash by .02 seconds. Douglas took second overall at the state meet, losing to Lander by 11 points.
“This year, I was a lot more excited for the team score (than individual medals). Gamble and I had done some serious number crunching to see what the team scores might end up like, and we were right there. I think me not winning hurt us a little bit and the incidents in the 300-meter hurdles was just bad luck,” Melton said, referencing Ty Etchemendy being disqualified for knocking a hurdle into another lane and Michael Addleman false starting. “What can I say about Ty Etchemendy. That kid is a freak. I can’t wait to come back and watch him over the next couple years. What happened to him was just bad luck.”
The weekend brought around another argument between Justin and his mom. He had prepaid $1,400 to go to Puerto Vallarta with about two dozen fellow seniors and chaperones. However, he still hadn’t passed the kidney stone. After much begging, Junan once again let Justin chase a once-in-a-lifetime experience at the risk of his health.
“I kind of got away with murder there,” Melton said.
Junan packed his bags with enough medication that he may now be on the DEA’s radar for suspicion of drug trafficking, but she let him get in the car and head off to the Denver airport.
At 3 a.m. at DIA, Melton gritted his teeth through 20 seconds of searing pain, which suddenly subsided when the kidney stone finally passed through the last of his system. Behind it was more than a week’s worth of urine.
“It took forever. I think I took the world record. It took at least three minutes,” Melton recalled.
When he was finally done, Melton greeted his friends, celebrating like he just scored a touchdown in the state championship. He also called his mom and left a voicemail with the good news. Now he could enjoy his vacation and she didn’t have to worry . . . as much.
“It timed up just perfect. Like I said. Someone has been looking out for me for awhile now.”
It was May 14, a Saturday. It was the second and final day of the 3A East Regional Track Meet. Melton was scheduled to compete in four different events. He won them all.
Tuesday is when the pain came. It was a sharp, stabbing pain that came out of his lower back and extended all across his midsection. It was the worst pain of his life for a kid whose suffered torn ligaments and broken bones on the football field.
Still in agony, Melton went to the emergency room on Wednesday morning.
After checking for a wide range of culprits like an appendicitis, the hospital took a CT scan and saw a kidney stone about the size of a pencil eraser. They gave him some pain pills to help while he was trying to pass it, but the pain made him so nauseous that he couldn’t keep them, or the food he was supposed to take them with, down. Doctors prescribed him a drug called Dilaudid to be given through IVs, which Melton said was several times stronger than morphine.
“I don’t know what happened, man,” Melton said. “Someone above was looking out for me because Thursday morning, I woke up and they were going to send me to Cheyenne for surgery to get the stone removed because it was blocking my urine from leaving my kidney and my kidney was swelling up.”
Before leaving to drive south on I-25 to Cheyenne, Melton called track coach Wes Gamble to let him know he wasn’t going to make it to the state meet in Casper. Gamble told Melton not to worry about it. His health comes first. On the side though, the two, along with the rest of the Bearcat squad, knew they couldn’t win a state championship without Melton.
“I hung up the phone with him and I could tell that he was about in tears, but I hung up the phone and sat there for a minute and beat the hell out of my bed in the hospital and got my knuckles all bloody,” Melton said. “I stood up, ripped the IVs out of my arm and said, ‘Mom, Dad, we are going to Casper.’”
Melton’s mom, Junan, took some convincing. She was concerned about him rupturing a kidney or worse during the state meet, where Melton was expected to compete in the long jump, 100-meter, 200-meter and 400-meter dashes over the next three days. His dad, Rusell, sided with his son. It was the last track meet of his high school career. If he could tolerate the pain, then go for it. Over the next 15 minutes, they talked mom into rolling the dice and drove west instead of south.
Junan texted Gamble’s wife right away, telling her to tell him not to scratch Melton from his races. If Gamble had already told the officials to replace Melton, there was no going back on it. She reached him as he was talking to the officials, but before he told them to scratch Melton.
“I’m just glad that didn’t happen. Someone was looking out for me,” Melton said.
The long jump was scheduled for 11 a.m. As Melton walked toward his teammates at Kelly Walsh High School, the wind was howling on the wrong side of freezing. Snow was falling. Melton’s face was almost as pale as the white flakes. His pupils were dilated. His head was loopy from all the painkillers still clinging to so many of his nerve endings.
“What are you doing here?” A stunned Gamble asked.
“I’m long jumping, coach,” Melton answered.
“Alright. We’ll see how you feel when you’re running down the runway,” Gamble said.
Running in the 200-meter dash prelims wasn’t very painful, but the sudden stopping and the hard landings of the long jump hurt. His swollen kidneys throbbed with each heavy step.
“You know what it’s like jumping up and down on a full stomach? Imagine that times 20,” Melton said.
After the long jump and 200-meter dash, Melton went to see a specialist in Casper. The doctor told him the intense pain on Tuesday and Wednesday was when the kidney stone was passing through three small passages in the ureter, which connects the kidneys to the bladder. He most likely got the kidney stone in the first place from being dehydrated. It has always been a bad habit. He never takes drinks with him on the bus, forgets to drink water during meets, and the team doesn’t stop for dinner on the way home.
“‘I’ll probably never get dehydrated again,” Melton said.
Friday, he felt a little better and by Saturday he was feeling great for the finals. He won three out of four events and broke his own 3A state record in the 100-meter dash by .02 seconds. Douglas took second overall at the state meet, losing to Lander by 11 points.
“This year, I was a lot more excited for the team score (than individual medals). Gamble and I had done some serious number crunching to see what the team scores might end up like, and we were right there. I think me not winning hurt us a little bit and the incidents in the 300-meter hurdles was just bad luck,” Melton said, referencing Ty Etchemendy being disqualified for knocking a hurdle into another lane and Michael Addleman false starting. “What can I say about Ty Etchemendy. That kid is a freak. I can’t wait to come back and watch him over the next couple years. What happened to him was just bad luck.”
The weekend brought around another argument between Justin and his mom. He had prepaid $1,400 to go to Puerto Vallarta with about two dozen fellow seniors and chaperones. However, he still hadn’t passed the kidney stone. After much begging, Junan once again let Justin chase a once-in-a-lifetime experience at the risk of his health.
“I kind of got away with murder there,” Melton said.
Junan packed his bags with enough medication that he may now be on the DEA’s radar for suspicion of drug trafficking, but she let him get in the car and head off to the Denver airport.
At 3 a.m. at DIA, Melton gritted his teeth through 20 seconds of searing pain, which suddenly subsided when the kidney stone finally passed through the last of his system. Behind it was more than a week’s worth of urine.
“It took forever. I think I took the world record. It took at least three minutes,” Melton recalled.
When he was finally done, Melton greeted his friends, celebrating like he just scored a touchdown in the state championship. He also called his mom and left a voicemail with the good news. Now he could enjoy his vacation and she didn’t have to worry . . . as much.
“It timed up just perfect. Like I said. Someone has been looking out for me for awhile now.”
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