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ObjectivesThe Centers for Disease Control disclosed over 600,000 cases of child abuse or neglect in 2016. Single-institution studies have shown that nonaccidental trauma (NAT) has higher complication rates than accidental trauma (AT). Nonaccidental trauma is disproportionately represented in infants. We hypothesized that NAT would increase the risk of mortality in infants. This study aims to provide a contemporary descriptive analysis for infant trauma patients and determine the association between NAT and mortality.MethodsInfants (

Background Perforated peptic ulcer (PPU) surgery mortality ranges 1% to 24%. We hypothesized a decrease in length of stay (LOS) with laparoscopic surgical repair (LSR) compared with open surgical repair (OSR). Methods Patients undergoing PPU surgery 2005 to 2015 were identified in NSQIP. LSR was compared with OSR 2005 to 2015. LSR 2005 to 2010 was compared with 2011 to 2015. OSR 2005 to 2010 was compared with 2011 to 2015. The primary outcome was LOS. Secondary outcomes were mortality and morbidity. Results Between 2005 and 2015, LSR had a decreased LOS, was more likely to wean from the ventilator, but had no significant difference in mortality compared with OSR. There was no significant difference in mortality for LSR or OSR over time. Conclusions When patients are appropriately selected, LSR for PPU is a viable alternative to OSR, decreasing LOS and pulmonary complications. This demonstrates significant benefit to patients and hospital throughput.

The purpose of this study is to assess informal consultations between radiologists and referring physicians as identified through an electronic medical record (EMR) search.The EMR was searched for physician notes containing either the term "radiologist" or "radiology" in combination with any of the following: "second opinion," "second-opinion," "2nd opinion," "2nd-opinion," "rereview," "re-review," "reread," "re-read," "overread," "over-read," "spoke with," "discussed with," or "reviewed with." A sample of 300 notes describing a consultation by a referring physician with a diagnostic radiologist was identified.Of the consultations, 73.3% were related to a specific previously interpreted imaging study, and 26.7% were related to other general management issues, including patient safety. Only 18.7% of the physicians' notes indicated the name of the consulted radiologist; a fraction of these consultations were with a radiologist other than the one who originally interpreted the study or with a radiologist at an outside institution. Of consultations with a local radiologist regarding a specific prior examination, 33.9% resulted in a new finding, a change in severity of a previously detected finding, or a change in management recommendation. Of consultations with a change from the initial report, 24.6% were documented by the radiologist via an addendum; 92.9% of these addenda agreed with the referring physicians' notes.Radiologists may be unaware of how their consultations are captured within physician notes that may be incomplete or misrepresent the communication. Radiology practices should consider developing policies requiring radiologists to document informal consultations potentially affecting patient management, while developing solutions to facilitate such documentation when it is not readily achieved through report addenda (e.g., through direct documentation by the radiologist in the EMR).

Background: Sepsis after emergency surgery is associated with a higher mortality rate than elective surgery, and total hospital costs increase by 2.3 times. This study aimed to identify risk factors for post-operative sepsis or septic shock in patients undergoing emergency surgery. Methods: A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program (NSQIP) by identifying patients undergoing emergency surgery between 2012 and 2015 and comparing those who developed post-operative sepsis or septic shock (S/SS) with those who did not. Patients with pre-operative sepsis or septic shock were excluded. Multiple logistic regression was used to identify risk factors for the development of S/SS in patients undergoing non-elective surgery. Results: Of 122,281 patients who met the inclusion criteria, 2,399 (2%) developed S/SS. Risk factors for S/SS were American Society of Anesthesiologists Physical Status (ASA PS) class 2 or higher (odds ratio [OR] 2.57; 95% confidence interval [CI] 2.19-3.02; p < 0.0001), totally dependent (OR 2.00, 95% CI 1.38-2.83; p = 0.00021) or partially dependent (OR 1.62, 95% CI 1.35-2.00; p < 0.0001) functional status, and male gender (OR 1.31; 95% CI 1.18-1.45; p < 0.0001). Compared with colorectal procedures, patients undergoing pancreatic (OR 2.33, CI 1.40-3.87; p = 0.00108) and small intestine (OR 1.27; CI 1.12-1.44; p = 0.00015) surgery were more likely to develop S/SS. Patients undergoing biliary surgery (OR 0.38; CI 0.30-0.48; p < 0.0001) were less likely to develop S/SS. Conclusions: Risk factors for the development of sepsis or septic shock are ASA PS class 2 or higher, partially or totally dependent functional status, and male gender. Emergency pancreatic or small intestinal procedures may confer a higher risk. Greater vigilance and early post-operative screening may be of benefit in patients with these risk factors.

Purpose To assess the content of currently available YouTube videos seeking to educate patients regarding commonly performed imaging examinations. Methods After initial testing of possible search terms, the first two pages of YouTube search results for "CT scan," "MRI," "ultrasound patient," "PET scan," and "mammogram" were reviewed to identify educational patient videos created by health organizations. Sixty-three included videos were viewed and assessed for a range of features. Results Average views per video were highest for MRI (293,362) and mammography (151,664). Twenty-seven percent of videos used a nontraditional format (eg, animation, song, humor). All videos (100.0%) depicted a patient undergoing the examination, 84.1% a technologist, and 20.6% a radiologist; 69.8% mentioned examination lengths, 65.1% potential pain/discomfort, 41.3% potential radiation, 36.5% a radiology report/results, 27.0% the radiologist's role in interpretation, and 13.3% laboratory work. For CT, 68.8% mentioned intravenous contrast and 37.5% mentioned contrast safety. For MRI, 93.8% mentioned claustrophobia, 87.5% noise, 75.0% need to sit still, 68.8% metal safety, 50.0% intravenous contrast, and 0.0% contrast safety. For ultrasound, 85.7% mentioned use of gel. For PET, 92.3% mentioned radiotracer injection, 61.5% fasting, and 46.2% diabetic precautions. For mammography, unrobing, avoiding deodorant, and possible additional images were all mentioned by 63.6%; dense breasts were mentioned by 0.0%. Conclusions Educational patient videos on YouTube regarding common imaging examinations received high public interest and may provide a valuable patient resource. Videos most consistently provided information detailing the examination experience and less consistently provided safety information or described the presence and role of the radiologist.

PURPOSE: Familial dysautonomia (FD) is a rare autosomal recessive disease that affects development of sensory and autonomic neurons, including those in the cranial nerves. We aimed to determine whether conventional brain magnetic resonance imaging (MRI) could detect morphologic changes in the trigeminal nerves of these patients. METHODS: Cross-sectional analysis of brain MRI of patients with genetically confirmed FD and age- and sex-matched controls. High-resolution 3D gradient echo T1-weighted sequences were used to obtain measurements of the cisternal segment of the trigeminal nerves. Measurements were obtained using a two-reader consensus. RESULTS: Twenty pairs of trigeminal nerves were assessed in 10 patients with FD and 10 matched controls. Median (interquartile range) cross-sectional area of the trigeminal nerves in patients with FD was 3.5 (2.1) mm(2) compared to 5.9 (2.0) mm(2) in controls (P

Clostridium difficile infection (CDI) is now the most common cause of health-care-associated infection and carries a mortality rate ranging from 5-30%. Previously, trauma patients in whom CDI developed were thought to represent a unique younger at-risk population. This study aimed to establish the incidence of CDI among adult trauma patients. We hypothesized that these patients would have increased risk of death, intensive care unit (ICU) length of stay (LOS), and hospital LOS compared with trauma patients without CDI.A retrospective study of all adult trauma patients admitted for greater than 48 hours to a single Level I trauma center between 2014 and 2016 was conducted. Analysis was performed using 1-to-5 propensity score matching with the aim to analyze the relationship between CDI, death, and other outcome variables.Between 2014 and 2016, of 4893 trauma patients admitted for48 hours, 27 (0.6%) patients received a diagnosis of CDI. These patients had a mean age of 55.6 years, mean injury severity score (ISS) of 22.4, and mortality rate of 9.1%. Of these patients, 22 were able to find appropriate propensity score matches. After adjusting for important covariables, there was no significant difference in death between CDI and non-CDI patients (odds ratio = 0.39, 95% confidence interval [CI]: 0.06-2.57, adjusted p = 0.66). In addition, there was no significant difference in ICU LOS between the two groups (relative mean [RM]: 1.55, 95% CI: 1.04-2.33, adjusted p = 0.0971). The CDI patients, however, did have a significantly longer hospital LOS, compared with non-CDI patients (RM = 1.39, 95% CI: 1.16-1.66, adjusted p = 0.0017).Among trauma patients admitted48 hours CDI occurred at a rate of 0.6%, much lower than anticipated. Patients in whom CDI developed had a significantly longer hospital LOS however, had no significant difference in odds of mortality or ICU LOS compared to patients without CDI.

Purpose To assess the effect on reader performance of an interactive case-based online tutorial for prostate magnetic resonance imaging (MRI) interpretation using Prostate Imaging and Reporting Data System (PI-RADS). Methods An educational website was developed incorporating scrollable multiparametric prostate MRI examinations with annotated solutions based on PI-RADS version 2. Three second-year radiology residents evaluated a separate set of 60 prostate MRI examinations both before and after review of the online case material, identifying and scoring dominant lesions. These 60 examinations included 30 benign cases and 30 cases with a dominant lesion demonstrating Gleason score ≥3 + 4 tumor on fusion-targeted biopsy. The readers’ pooled performance was compared between the 2 sessions using logistic regression and Wilcoxon signed rank tests. Results All readers completed the online material within four-hours. Review of the online material significantly improved sensitivity (from 57.8%-73.3%, P = 0.003) and negative predictive value (from 69.2%-78.2%, P = 0.049), but not specificity (from 70.0%-67.8%, P = 0.692) or positive predictive value (from 59.6%-64.7%, P = 0.389). Reader confidence (1-10 scale; 10 = maximal confidence) also improved significantly (from 5.6 ± 2.7 to 6.3 ± 2.6, P = 0.026). However, accuracy of assigned PI-RADS scores did not improve significantly (from 45.5%-53.3%, P = 0.149). Conclusion An online interactive case-based website in prostate MRI interpretation improved novice readers’ sensitivity and negative predictive value for tumor detection, as well as readers’ confidence. This online material may serve as a resource complementing existing traditional methods of instruction by providing a more flexible educational experience among a larger volume of learners. However, further more targeted educational initiatives regarding the proper application of PI-RADS remain warranted.

The aim of this study is to determine the diagnostic value of cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE), cine imaging, and resting first-pass perfusion (FPP) in the evaluation for ischemic (IC) versus non-ischemic (NIC) cardiomyopathy in new onset heart failure with reduced (≤40%) left ventricular ejection fraction (HFrEF). A retrospective chart review analysis identified 83 patients between January 2009 and June 2012 referred for cardiac magnetic resonance imaging (CMR) evaluation for new onset HFrEF with coronary angiography performed within 6 months of CMR. The diagnosis of IC was established using Felker’s criteria on coronary angiography. CMR sequences were evaluated for the presence of patterns suggestive of severe underlying coronary artery disease as the cause of HFrEF (subendocardial and/or transmural LGE, regional wall motion abnormality on cine, regional hypoperfusion defect on resting FPP). Discriminative power was assessed using receiver operator characteristics curve analysis. Coronary angiography identified 36 patients (43%) with IC. Presence of subendocardial and/or transmural LGE alone demonstrated good discriminative power (c-statistic 0.85, 95% confidence interval 0.76–0.94) for the diagnosis of IC. The presence of an ischemic pattern on both LGE and cine sequences resulted in a specificity of 87% for the diagnosis of IC, while the absence of an ischemic pattern on both LGE and cine sequences resulted in a specificity of 94% for the diagnosis of NIC. Addition of resting FPP on a subset of patients did not improve diagnostic values. In conclusion, CMR has potential value in the diagnostic evaluation of IC versus NIC.

The propensity score is defined as the probability of each individual study subject being assigned to a group of interest for comparison purposes. Propensity score adjustment is a method of ensuring an even distribution of confounders between groups, thereby increasing between group comparability. Propensity score analysis is therefore an increasingly applied statistical method in observational studies. The purpose of this article was to provide a step-by-step nonmathematical conceptual guide to propensity score analysis with particular emphasis on propensity score matching. A software program code used for propensity score matching was also presented.

Background In patients newly diagnosed with heart failure, coronary angiography is the current gold standard in differentiating underlying coronary artery disease and non-ischemic cardiomyopathy. However, CMR is emerging as an attractive alternative that can provide substantially more diagnostic information with its multiple sequences, while also demonstrating a superior safety profile. In this study, we evaluated the diagnostic ability of late gadolinium enhancement (LGE), cine, and first pass perfusion (FPP) in diagnosing ischemic cardiomyopathy compared to coronary angiography (CA).