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original Paper x-RAYS ReFeRRAL IN AN eMeRGeNCY DePARtMeNt Zohair Jamil Gazzaz – MB, ChB, PhD, Health Research Centre Director, Consultant Diabetes, Al-Noor Specialist Hospital, Makkah, Saudi Arabia; Khalid Obeid Dhafar – FACS, FRCS, Consultant Surgeon, Al-Noor Specialist Hospital, Makkah, Saudi Arabia; Abdul Fatah Sindy, MBBS, MD, Head of Emergency Department, Consultant Emergency Medicine, Al-Noor Specialist Hospital, Makkah, Saudi Arabia; Mian Usman Farooq – MBBS, MSc, Performance Measurement Manager, Al-Noor Specialist Hospital, King Abdullah Medical City, Makkah, Saudi Arabia; Shakeel Ahmad Mian, MBBS, Resident Emergency Department, Al-noor Specialist Hospital, Makkah, Saudi Arabia.

удК 616-083.98-073.75(532)(045)=111 Оригинальная статья Практика рентгенологичеСкого оБСледованиЯ в отделении экСтренной Помощи Зохаир Джамил Газзаз – Саудовская Аравия, Мака, Специализированная больница Ал-Нор, директор исследовательского центра здоровья, доктор философии; Халид Обейд Дафар – Саудовская Аравия, Мака, Специализированная больница Ал-Нор, консультант хирургического отделения; Абдул Фата Синди – Саудовская Аравия, Мака, Специализированная больница Ал-Нор, заведующий отделением экстренной помощи, доктор медицины; Миан Усман Фарук – Саудовская Аравия, Мака, Специализированная Больница Ал-Нор, магистр естественных наук; Шакил Ахмад Миан – Саудовская Аравия, Мака, Специализированная больница Ал-Нор, отделение экстренной помощи, врач-ординатор.

дата поступления – 11.06.2010 г. дата принятия в печать – 16.09.2010 г.

Gazzaz Zohair Jamil, Dhafar Khalid Obeid, Sindy Abdul Fatah, Farooq Mian Usman, Mian Shakeel Ahmad. X-rays referral in an emergency department // saratov Journal of medical scientific Research. 2010. vol. 6, № 3. p. 612–614.

this study highlighted referral rate for x-rays with positive findings in an emergency department of a tertiary care hospital in Makkah, Saudi arabia.

this was a retrospective review of emergency department(eD) cards/files of patients visited (eD) of alnoor Specialist hospital, Makkah, Saudi arabia, during the month of april, 2006g.

the total of 660 (22%) out of 2980 eD patients were included in the study and 1472 x-rays of different regions were done for them. Majority 288 (43.3%) were below 24yrs of age while males 372 (56.3%) and Saudis 400 (60%) were predominant. 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. It was found that lower limb was exposed 384 times (26%), followed by chest 320 (21.7%). overall 240 (16.3%) x-rays had positive findings with majority of upper limb 60 (50%) followed by chest 72 (22.5%). Pelvis & perineum had no positive x-ray. Patients from injury & poisoning were predominant 224 (33.9%) followed by respiratory disorders 104 (15.7%).

eighty four percent x-rays had no positive findings. Majority of x-rays were done for lower limb. neck, pelvis & perineum x-rays had no positive findings.

Key words: x-ray, emergency, Radiology, Makkah.

Газзаз Зохаир Джамил, Дафар Халид Обейд, Синди Абдул Фата, Фарук Миан Усман, Миан Шакил Ахмад. Практика рентгенологического обследования в отделении экстренной помощи // Саратовский научно-медицинский журнал. 2010. Т. 6, № 3. С. 612–614.

Исследование по выявлению доли рентгенологических обследований с положительными заключениями, в том числе всех обследований, проводимых в отделении скорой помощи при центральной больнице Мака в Саудовской Аравии. Ретроспективное рассмотрение карточек пациентов, обратившихся в отделение неотложной помощи в течение апреля 2006 г., послужило методом данного научного исследования. Из 2980 экстренных пациентов 660 (22%) приняли участие в исследовании. были проведены 1472 рентгенологические процедуры.

большинство обследованных – 288 (43,3%) человек – в возрасте до 24 лет. Превалировали жители Саудовской Аравии – 400 (60%) человек; 372 (56,3%) пациента – мужского пола. Выписаны из отделения 572 (86,6%) исследуемых. Зарегистрировано 4 (0,6%) случая летального исхода. 620 (93,9%) пациентов подвергались рентгенологическому исследованию от 1 до 4 раз. четыре (0,6%) человека более восьми раз проходили данную процедуру. Обследование нижних конечностей по частотности составило 384 (26%) раза, обследование грудной клетки – 320 (21,7%) раз. большинство положительных результатов было отмечено при исследовании верхних конечностей и грудной клетки. Обследование области шеи, таза и промежностей не дало положительных результатов. Пациенты с различными повреждениями и отравлениями превалировали над пациентами с заболеваниями дыхательных путей. Не дали положительных результатов 84% ренгенологических обследований.

ключевые слова: рентгенологическое обследование, экстренная медицина, рентгенология, Мака.

introduction. Since the discovery of x-rays in 1895, world-wide at a rate of 5 to 10% per year [2-6]. conventhe field of diagnostic radiology has grown quickly [1]. tional radiology constitutes more than 80% of the daily the utilization of radiological investigations is increasing work of any radiology department and thus forms a sizeable amount of effort and cost [7, 8].

corresponding author – Mian usman farooq MbbS, Msc.

In human tissue, the ionization by x-rays can cause Postal address: Mian usman farooq, damage to Dna and cells, but it can also penetrate the Performance Measurement Manager, king abdullah Medical city, body to allow noninvasive visualization of the internal P.o. box 57657, Post code: anatomy [9]. contemporary medicine relies heavily on Makkah, Saudi arabia radiological and medico nuclear investigations and fax: +966 (02) 5668581.

Source of financial Support: hospital budget procedures. however, the often essential information category of article: original article.

derived from such investigations is obtained at a risk e-mail: hrd_alnoor@yahoo.com Саратовский научно-медицинский журнал. 2010. Том 6, № 3.

CLINICAL LABORAtORY DIAGNOStICS Table that few doctors are fully aware of. use of radiation for medical examinations and tests is the largest manmade demographic data source of radiation exposure. according to united nano % tions, an average of 2.4mSv/year radiations come from natural sources. the medical sources of radiation were 0-24 288 43.about one fifth of the natural radiation in 1987, closes 25-44 208 31.to half in 1993, and almost 100% of natural radiation in age groups (years) 1997 in most affluent countries [10].

45-64 112 16.emergency departments are major source of requests >64 52 7.for radiographs. the aim of this study was to identify the M 372 56.level of referrals from the emergency department for xgender rays and to estimate its overutilization in the sense of susf 288 43.pected positive findings in a tertiary care referral unit, ie S 400 al-noor Specialist hospital, Makkah, Saudi arabia.

nationality methods. this study was performed at the eD n/S 260 of a 520 bed tertiary care referral teaching hospital in Makkah, Saudi arabia, the al-noor Specialist hospital Table with an annual average of about 229,200 eD visits. the outcome of patients eD typically contains 72 nurses and a total of 40 doctors, including consultants, specialists and residents. eD docno % tors could call resident or specialist of the day or on call Discharged 572 86.(RoD, SoD) of all specialties, to take second opinion for the patients with expected admissions or complications. admitted 72 10.only the (SoD) could admit a patient as per hospital polDaMa 8 outcome icy and depending upon the patient’s condition. al-noor Referred 4 0.hospital’s eD is fully equipped with a total department area of 2315 m2 having 54 beds in different areas includDead 4 0.ing triage area, adult care area (aca), ob/gyne, criti1-4 620 93.cal care area (cca) and Paediatrics care area (Pca).

this eD also has an emergency Pharmacy, Radiology 5-8 36 5.no of exposures Department and laboratory. there is a surgical facility >8 4 0.with an operation room, and ent, eye and Dental procedure rooms are also present for emergency patients.

Table this is a retrospective study comprising of data coldetail of region wise exposure with positive findings lected from emergency department (eD) cards/files of patients who visited the eD during the one month peno of no of positive riod of april, 2006g. the eD cards were reviewed for Regions % % x-rays x-rays age, gender, nationality, no of x-rays advised and their findings, final discharging diagnosis according to Inter- 1 lower limb 384.0 26.1 24.0 6.national classification of Diagnosis version-10 (IcD-10) 2 chest 320.0 21.7 72.0 22.and final outcome. the age was divided into 0-24, 253 head(skull) 176.0 12.0 32.0 18.44, 45-64, >64, gender was expressed as male, female, while nationality was detailed as Saudies, non-saudies.

4 neck 116.0 7.9 0.0 0.the subjects exposed to x-rays had been enumerated, 5 abdomen 268.0 18.2 36.0 13.and body was divide into regions, ie lower limb, upper limb, chest, head, neck, abdomen, thoraco-lumbo-sacral 6 upper limb 120.0 8.2 60.0 50.spine, pelvis and premium. Regions were enlisted from 7 thoracosmallest to largest number of times they exposed to xlumbo-sacral rays. the clinical notes of each x-ray written by radiolo- spine 72.0 4.9 16.0 22.gist had been reviewed for findings suspected by the eD 8 Pelvis & physician before advising x-rays or findings coherent perinium 16.0 1.1 0.0 0.with his initial working diagnosis considered as positive.

total 1472.0 100.0 240.0 16.each patient,s final diagnosis was categorized according to IcD-10 and arranged in Major Diagnostic categories It was found that lower limb was exposed 384 times (MDcs). Data was analyzed by using Microsoft excel (26%), followed by chest 320 (21.7%). overall 2003 version.

(16.3%) x-rays had positive findings with majority of upwe declare that we have no financial or personal per limb 60 (50%) followed by chest 72 (22.5%). Pelvis & relationship(s) which may have inappropriately influperineum had no positive x-ray out of 16 (1.1%) (table 3).

enced us in writing this paper.

a total of 13 Major Diagnostic categories (MDcs) Results. a total number of 660 (22%) patients out were found for the patients and injury & poisoning were of 2980 had been referred to radiology department for predominant (S00-t98) 224 (33.9%) followed by respix-ray from eD of alnoor Specialist hospital during study ratory disorders (J00-J99) 104 (15.7%).endocrine (e00period. Majority 288 (43.3%) were below 24yrs of age e99), neoplasm (c00-D48) and congenital malformation while males 372 (56.3%) and Saudis 400 (60%) were (q00-q99) cases were equal, ie 4 (0.6%) (table 4).

predominant (table 1).

the discharged patients were 572 (86.6%), and 4 discussion. It is both ethically and economically de(0.6%) were died. Six hundred and twenty (93.9%) pa- sirable to restrict the use of diagnostic medical radiation tients got exposures rang of 1-4 while only four (0.6%) to only those who will benefit from it. however, patients got more than eight exposures to x-rays (table 2). should not refuse diagnostic tests based on an exaggerSaratov Journal of Medical Scientific Research. 2010. Vol. 6, № 3.

614 клиничеСкаЯ лаБораторнаЯ диагноСтика Table subjects’ detail according to major diagnostic categories (mdcs) s/n Major Diagnostic categories IcD-10 no % 1 Injury, poisoning & certain other consequences of external causes S00-t98 224 33.2 Diseases of respiratory system J00-J99 104 15.3 Symptoms, signs & abnormal clinical & laboratory findings not elsewhere classified R00-R99 76 11.4 Diseases of digestive system k00-k99 60 5 Diseases of circulatory system I00-I99 52 7.6 Diseases of genitourinary system n00-n99 48 7.7 external causes of morbidity& mortality V00-y98 48 7.8 Diseases of musculoskeletal system and connective tissue M00-M99 20 9 Diseases of nervous system g00-g99 8 1.10 Diseases of skin and subcutaneous tissues l00-l99 8 1.11 endocrine, nutritional & metabolic diseases e00-e99 4 0.12 neoplasm c00-D48 4 0.13 congenital malformations, deformities &chromosomal abnormalities q00-q99 4 0.total 660 ated estimation of the risks because most of these tests according to International classification for Diagnosis involve low doses of radiation. It is probable that risks version 10, ie IcD-10 and arranged in Major Diagnostic categories (MDcs) which is not mentioned in any above derived from studies of the atomic bomb survivors, who study.

were exposed to high doses of radiation, overestimate conclusion. x-ray prediction of our accident and the risks at low doses. no evidence of thyroid cancer, emergency physicians were better than other studies leukemia or non-hodgkin lymphoma has been found in patients exposed to diagnostic levels of ionizing radia- but still there is a need of clear guidelines for prescribing x-rays in our eD setup.

tion. for most diagnostic tests, the risks arising from radiation exposure are too small to be observed and the Reference benefits will almost always outweigh the risk. there is in1. Report of a joint Iaea/who expert committee: the medicreasing evidence that the risks associated with medical cal uses of ionizing radiation and radioisotopes // who technical diagnostic radiation exposure are substantially less than Report Series. 492 geneva: who, 1972.

that predicted from high-dose radiation [11]. our study 2. evans k.t. the radiologist’s dilemma // br. J. Radiol. 1977.

was limited, retrospective with one month emergency № 50. Р. 299-301.

patients who referred for radiography, ie x-ray contrary 3. clinical audit in diagnostic radiology: [editorial] // br. Med.

J. 1977. № 6085. Р. 479-480.

to the prospective one of Richards in which, study period 4. hall f.M. overutilization of radiological examinations // Rawas one week with study sample (1436) of whom diology. 1976. № 120. Р. 443-448.

(44%) were radio graphed, which is higher than our study, 5. Reducing tests: [editorial] // lancet. 1981. № 2. Р. 539ie (22% out of total eD visits). In our study only emergen540.

cy cards of those patients were studied who got x-ray 6. beentjes l.b., timmermans c.w.M. age- and sex-specific while in his, all the emergency cards had been studied in radiographic examination frequency in the netherlands // br. J.

Radiol. 1990. № 63. Р. 691-697.

detail. his study had been conducted by only emergency 7. Palmer P.e.S., cockshott w.P. the appropriate use of didepartments notes, illustrated that the commonest site of agnostic imaging: avoidance of the red goggle syndrome // J. am.

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