Publications by authors named "P Sierzenski"

39 Publications

ACR Appropriateness Criteria head trauma--child.

J Am Coll Radiol 2014 Oct 20;11(10):939-47. Epub 2014 Aug 20.

Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Head trauma is a frequent indication for cranial imaging in children. CT is considered the first line of study for suspected intracranial injury because of its wide availability and rapid detection of acute hemorrhage. However, the majority of childhood head injuries occur without neurologic complications, and particular consideration should be given to the greater risks of ionizing radiation in young patients in the decision to use CT for those with mild head trauma. MRI can detect traumatic complications without radiation, but often requires sedation in children, owing to the examination length and motion sensitivity, which limits rapid assessment and exposes the patient to potential anesthesia risks. MRI may be helpful in patients with suspected nonaccidental trauma, with which axonal shear injury and ischemia are more common and documentation is critical, as well as in those whose clinical status is discordant with CT findings. Advanced techniques, such as diffusion tensor imaging, may identify changes occult by standard imaging, but data are currently insufficient to support routine clinical use. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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http://dx.doi.org/10.1016/j.jacr.2014.07.017DOI Listing
October 2014

Credentialing for emergency ultrasonography.

Ann Emerg Med 2014 Sep;64(3):331-2

Department of Emergency Medicine, St. Francis Hospital, Columbus, GA.

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http://dx.doi.org/10.1016/j.annemergmed.2014.05.024DOI Listing
September 2014

Ultrasound-guidance can reduce adverse events during femoral central venous cannulation.

J Emerg Med 2014 Apr 22;46(4):519-24. Epub 2014 Jan 22.

Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware.

Background: Ultrasound-guidance for internal jugular central venous cannulation (CVC) has become the recommended best practice and has been shown to improve placement success and reduce complications. There is a dearth of studies that evaluate emergency point-of-care ultrasound guidance of femoral CVC.

Objective: Our aim was to determine if point-of-care ultrasound guidance for femoral CVC decreases adverse events and increases the likelihood of successful placement when compared with the landmark technique.

Methods: We conducted an Institutional Review Board-approved, prospective, observational study of consecutive patients who required CVC. Physicians who performed CVC completed a standardized, web-based data sheet for a national CVC registry. We evaluated single-institution data regarding CVC site, ultrasound usage, CVC indication, and mechanical complications (e.g., pneumothorax, arterial puncture, failed access, catheter misdirection, and hematoma). The study period was between January 2006 and June 2010. Analysis using Pearson's χ(2) and Agresti-Coull binomial confidence intervals was performed; significance was defined as p < 0.05.

Results: We evaluated data for 143 patients who had femoral CVC in our institution. Sixty CVCs (42%) were performed under ultrasound guidance, 83 (58%) via landmark technique (p = 0.0159); 3.3% of femoral central venous lines placed by ultrasound guidance had recorded adverse events compared with 9.6% for the landmark technique (p = 0.145). There was no statistically significant difference in complications between ultrasound-guidance and landmark techniques. Our data showed a trend toward decreased rates of arterial puncture and reduced cannulation attempts resulting in improved placement success.

Conclusions: Our experience shows that ultrasound guidance for femoral CVC might decrease complications and improve placement success, although we cannot recommend this approach without additional data. We recommend a larger study to further evaluate this technique.
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http://dx.doi.org/10.1016/j.jemermed.2013.08.023DOI Listing
April 2014

Applications of justification and optimization in medical imaging: examples of clinical guidance for computed tomography use in emergency medicine.

J Am Coll Radiol 2014 Jan 13;11(1):36-44. Epub 2013 Oct 13.

National Council on Radiation Protection and Measurements, Bethesda, Maryland.

Availability, reliability, and technical improvements have led to continued expansion of computed tomography (CT) imaging. During a CT scan, there is substantially more exposure to ionizing radiation than with conventional radiography. This has led to questions and critical conclusions about whether the continuous growth of CT scans should be subjected to review and potentially restraints or, at a minimum, closer investigation. This is particularly pertinent to populations in emergency departments, such as children and patients who receive repeated CT scans for benign diagnoses. During the last several decades, among national medical specialty organizations, the American College of Emergency Physicians and the American College of Radiology have each formed membership working groups to consider value, access, and expedience and to promote broad acceptance of CT protocols and procedures within their disciplines. Those efforts have had positive effects on the use criteria for CT by other physician groups, health insurance carriers, regulators, and legislators.
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http://dx.doi.org/10.1016/j.jacr.2013.09.023DOI Listing
January 2014

Applications of justification and optimization in medical imaging: examples of clinical guidance for computed tomography use in emergency medicine.

Ann Emerg Med 2014 Jan 15;63(1):25-32. Epub 2013 Oct 15.

National Council on Radiation Protection and Measurements, Bethesda, MD.

Availability, reliability, and technical improvements have led to continued expansion of computed tomography (CT) imaging. During a CT scan, there is substantially more exposure to ionizing radiation than with conventional radiography. This has led to questions and critical conclusions about whether the continuous growth of CT scans should be subjected to review and potentially restraints or, at a minimum, closer investigation. This is particularly pertinent to populations in emergency departments, such as children and patients who receive repeated CT scans for benign diagnoses. During the last several decades, among national medical specialty organizations, the American College of Emergency Physicians and the American College of Radiology have each formed membership working groups to consider value, access, and expedience and to promote broad acceptance of CT protocols and procedures within their disciplines. Those efforts have had positive effects on the use criteria for CT by other physician groups, health insurance carriers, regulators, and legislators.
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http://dx.doi.org/10.1016/j.annemergmed.2013.08.027DOI Listing
January 2014
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