Практика рентгенологического обследования в отделении экстренной помощи

¹ Introduction . Since the discovery of x-rays in 1895, the field of diagnostic radiology has grown quickly [1]. The utilization of radiological investigations is increasing

Corresponding Author – Mian Usman Farooq MBBS, Msc.

Postal Address: Mian Usman Farooq,

Performance Measurement Manager,

King Abdullah Medical City,

P.O. Box 57657, Post Code: 21955

Makkah, Saudi Arabia

Fax: +966 (02) 5668581.

Source of Financial Support: Hospital Budget

Category of Article: Original article.

world-wide at a rate of 5 to 10% per year [2-6]. Conventional radiology constitutes more than 80% of the daily work of any radiology department and thus forms a sizeable amount of effort and cost [7, 8].

In human tissue, the ionization by X-rays can cause damage to DNA and cells, but it can also penetrate the body to allow noninvasive visualization of the internal anatomy [9]. Contemporary medicine relies heavily on radiological and medico nuclear investigations and procedures. However, the often essential information derived from such investigations is obtained at a risk that few doctors are fully aware of. Use of radiation for medical examinations and tests is the largest manmade source of radiation exposure. According to United Nations, an average of 2.4mSv/year radiations come from natural sources. The medical sources of radiation were about one fifth of the natural radiation in 1987, closes to half in 1993, and almost 100% of natural radiation in 1997 in most affluent countries [10] .

Emergency departments are major source of requests for radiographs. The aim of this study was to identify the level of referrals from the emergency department for X-rays and to estimate its overutilization in the sense of suspected positive findings in a tertiary care referral unit, ie Al-noor Specialist Hospital, Makkah, Saudi Arabia.

Methods. This study was performed at the ED of a 520 bed tertiary care referral teaching hospital in Makkah, Saudi Arabia, the Al-Noor Specialist Hospital with an annual average of about 229,200 ED visits. The ED typically contains 72 nurses and a total of 40 doctors, including consultants, specialists and residents. ED doctors could call resident or specialist of the day or on call (ROD, SOD) of all specialties, to take second opinion for the patients with expected admissions or complications. Only the (SOD) could admit a patient as per hospital policy and depending upon the patient’s condition. Al-Noor Hospital’s ED is fully equipped with a total department area of 2315 m2 having 54 beds in different areas including Triage Area, Adult Care Area (ACA), Ob/Gyne, Critical Care Area (CCA) and Paediatrics Care Area (PCA). This ED also has an Emergency Pharmacy, Radiology Department and Laboratory. There is a surgical facility with an Operation room, and ENT, Eye and Dental procedure rooms are also present for emergency patients.

This is a retrospective study comprising of data collected from emergency department (ED) cards/files of patients who visited the ED during the one month period of April, 2006G. The ED cards were reviewed for age, gender, nationality, no of X-rays advised and their findings, final discharging diagnosis according to International Classification of Diagnosis version-10 (ICD-10) and final outcome. The age was divided into 0-24, 2544, 45-64, >64, gender was expressed as male, female, while nationality was detailed as Saudies, non-saudies. The subjects exposed to X-rays had been enumerated, and body was divide into regions, ie lower limb, upper limb, chest, head, neck, abdomen, thoraco-lumbo-sacral spine, pelvis and premium. Regions were enlisted from smallest to largest number of times they exposed to X-rays. The clinical notes of each X-ray written by radiologist had been reviewed for findings suspected by the ED physician before advising X-rays or findings coherent with his initial working diagnosis considered as positive. Each patient,s final diagnosis was categorized according to ICD-10 and arranged in Major Diagnostic Categories (MDCs). Data was analyzed by using Microsoft excel 2003 version.

We declare that we have no financial or personal relationship(s) which may have inappropriately influenced us in writing this paper.

Results. A total number of 660 (22%) patients out of 2980 had been referred to radiology department for X-ray from ED of alnoor Specialist Hospital during study period. Majority 288 (43.3%) were below 24yrs of age while males 372 (56.3%) and Saudis 400 (60%) were predominant (Table 1).

The discharged patients were 572 (86.6%), and 4 (0.6%) were died. Six hundred and twenty (93.9%) patients got exposures rang of 1-4 while only four (0.6%) got more than eight exposures to X-rays (Table 2).

Table 1

Demographic data

		no	%
	0-24	288	43.6
	25-44	208	31.5
Age groups (years)	45-64	112	16.9
	>64	52	7.8
	M	372	56.3
Gender	F	288	43.6
	S	400	60
Nationality	N/S	260	40
			Table 2
Outcome of Рatients
		no	%
	Discharged	572	86.6
	Admitted	72	10.9
Outcome	DAMA	8	102
	Referred	4	0.6
	Dead	4	0.6
	1-4	620	93.9
no of exposures	5-8	36	5.4
	>8	4	0.6

Table 3

Detail of region wise exposure with positive findings

	Regions	No of X-rays	%	No of positive X-rays	%
1	Lower limb	384.0	26.1	24.0	6.3
2	Chest	320.0	21.7	72.0	22.5
3	Head(skull)	176.0	12.0	32.0	18.2
4	Neck	116.0	7.9	0.0	0.0
5	Abdomen	268.0	18.2	36.0	13.4
6	Upper limb	120.0	8.2	60.0	50.0
7	Thoraco-lumbo-sacral spine	72.0	4.9	16.0	22.2
8	Pelvis & perinium	16.0	1.1	0.0	0.0
	Total	1472.0	100.0	240.0	16.3

Discussion. It is both ethically and economically desirable to restrict the use of diagnostic medical radiation to only those who will benefit from it. However, patients should not refuse diagnostic tests based on an exagger-

Table 4

Subjects’ detail according to Major Diagnostic Categories (MDCs)

according to International Classification for Diagnosis version 10, ie ICD-10 and arranged in Major Diagnostic Categories (MDCs) which is not mentioned in any above study.

Conclusion. X-ray prediction of our accident and emergency physicians were better than other studies but still there is a need of clear guidelines for prescribing X-rays in our ED setup.