Correspondence / American Journal of Emergency Medicine 33 (2015) 834-855

Anucha Apisarnthanarak, MD

841

Zachary H. Seeskin, MS

Division of Infectious Diseases, Thammasart University Hospital

Pratumthani, Thailand Corresponding author. Division of Infectious Diseases Thammasart University Hospital, Pratumthani 12120 Thailand

Tel.: +66 81 987 2030

E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2015.03.009

References

1. Apisarnthanarak P, Suvannarerg V, Pattaranutaporn P, Charoensak A, Raman SS, Apisarnthanarak A. Alvarado score: can it reduce unnecessary CT scans for evalua- tion of acute appendicitis? Am J Emerg Med 2015;33:266-70.
2. Hernanz-Schulman M. CT and US in the diagnosis of appendicitis: an argument for CT. Radiology 2010;255:3-7.
3. shared decision making in patie”>Karabulut N, Kiroglu Y, Herek D, Kocak TB, Erdur B. Feasibility of low-dose unenhanced multi-detector CT in patients with suspected acute appendicitis: com- parison with sonography. Clin Imaging 2014;38:296-301.
4. Wan MJ, Krahn M, Ungar WJ, Caku E, Sung L, Medina LS, et al. Acute appendicitis in young children: cost-effectiveness of US versus CT in diagnosis-a Markov decision analytic model. Radiology 2009;250:378-86.
5. Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S, et al. US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 2006;241:83-94.
6. Keyzer C, Zalcman M, De Maertelaer V, Coppens E, Bali MA, Gevenois PA, et al. Com- parison of US and unenhanced multi-detector row CT in patients suspected of hav- ing acute appendicitis. Radiology 2005;236:527-34.
7. Poortman P, Lohle PN, Schoemaker CM, Oostvogel HJ, Teepen HJ, Zwinderman KA, et al. Comparison of CT and sonography in the diagnosis of acute appendicitis: a blinded prospective study. AJR Am J Roentgenol 2003;181:1355-9.
8. Pickuth D, Heywang-Kobrunner SH, Spielmann RP. Suspected acute appendicitis: is ultrasonography or computed tomography the preferred imaging technique? Eur J Surg 2000;166:315-9.
9. Rhea JT, Halpern EF, Ptak T, Lawrason JN, Sacknoff R, Novelline RA. The status of appendiceal CT in an urban medical center 5 years after its introduction: experience with 753 patients. AJR Am J Roentgenol 2005;184:1802-8.
10. Rao PM, Rhea JT, Novelline RA, McCabe CJ, Lawrason JN, Berger DL, et al. Helical CT technique for the diagnosis of appendicitis: prospective evaluation of a focused ap- pendix CT examination. Radiology 1997;202:139-44.
11. Raman SS, Lu DS, Kadell BM, Vodopich DJ, Sayre J, Cryer H. Accuracy of nonfocused helical CT for the diagnosis of acute appendicitis: a 5-year review. AJR Am J Roentgenol 2002;178:1319-25.
12. Ozkan S, Duman A, Durukan P, Yildirim A, Ozbakan O. The accuracy rate of Alvarado score, ultrasonography, and computerized tomography scan in the diagnosis of acute appendicitis in our center. Niger J Clin Pract 2014;17:413-8.

    In response to “Scope of shared decision making in patients with Psychologic complaints“

    

    To the Editor,

    We agree with the letter by Fukui et al [1] that Shared Decision Mak- ing (SDM) is important in the care of all patients, including those with psychologic complaints. In fact, a number of factors and situations affect patient preferences for SDM, including acuity, Severity of disease, ethnic- ity of patients, socioeconomic status, and the type of care delivered [2-6]. Our pilot study was designed to establish a foundation and proof of concept for future studies. To understand how various populations view SDM, future studies can focus on particular groups of patients, in- cluding nonnative language speakers and those of different sexes, ages, races, ethnicities, socioeconomic statuses, Disease states, etc. as well as patients with Psychiatric chief concerns. These studies will need to be designed and adequately powered to study any specific group of pa- tients. We uphold that SDM is critical to Quality patient care and that fur- ther studies need to be carried out to efficiently implement these

    principles in the unique setting of the emergency department.

    Daniel J. Reschke, BS Northwestern University Feinberg School of Medicine Corresponding author. 4636 N Racine Ave #3, Chicago, IL, 60640

    Tel.: + 801 505 8645

    E-mail address: [email protected]

    Northwestern University, Department of Statistics

    Elizabeth A. Hahn, MA Northwestern University Feinberg School of Medicine Department of Medical Social Sciences

    Peter S. Pang, MD

    Indiana University School of Medicine, Department of Emergency Medicine

    http://dx.doi.org/10.1016/j.ajem.2015.03.011

    References

    Fukui S, Salyers MP, Matthias MS, Collins L, Thompson J, Coffman M, et al. Predictors of shared decision making and level of agreement between consumers and providers in psychiatric care. Community Ment Health J 2014;50(4):375-82 [PubMed PMID: 23299226. Pubmed Central PMCID: 3980460].

13. Deber RB, Kraetschmer N, Irvine J. What role do patients wish to play in treatment de- cision making? Arch Intern Med 1996;156(13):1414-20 [PubMed PMID: 8678709].
14. Muller-Engelmann M, Keller H, Donner-Banzhoff N, Krones T. Shared decision making in medicine: the influence of situational treatment factors. Patient Educ Couns 2011; 82(2):240-6 [PubMed PMID: 20542403. Epub 2010/06/15. eng].
15. Patel SR, Bakken S. Preferences for participation in decision making among ethnically diverse patients with anxiety and depression. Community Ment Health J 2010;46(5): 466-73 [PubMed PMID: 20556512. Pubmed Central PMCID: PMC2931338. Epub

    2010/06/18. eng].

    van den Brink-Muinen A, Spreeuwenberg P, Rijken M. Preferences and experiences of chronically ill and disabled patients regarding shared decision-making: does the type of care to be decided upon matter? Patient Educ Couns 2011;84(1):111-7 [PubMed PMID: 20817453. Epub 2010/09/08. eng].

16. Wilkinson C, Khanji M, Cotter PE, Dunne O, O’Keeffe ST. Preferences of acutely ill patients for participation in medical decision-making. Qual Saf Health Care 2008; 17(2):97-100 [PubMed PMID: 18385401].

    Scope of shared decision making in patients with psychologic complaints?

    

    To the Editor,

    We read with great pleasure the work by Reschke et al [1]. The authors have done commendable work in emphasizing the significance of shared decision making (SDM) in improving patient satisfaction and reduc- ing health care cost [2]. In spite of its inherent challenges, SDM is rightly being increasingly implemented in the emergency department (ED) resulting in enhanced patient-centric care [3]. Although the burden of shared effective decision making in terms of options, risks, and benefits may appear challenging in an individual with psychologic complaints, SDM has become important in establishing the long-term goal of care in these subgroup of patients as well. In the presented study, however, authors did not enroll patients with psychologic complaints. We would like to high- light our views on the shifting paradigm of SDM in Psychiatric patients.

    Prior studies have shown that patients with psychiatric illnesses do prefer to be involved in SDM [4]. In addition, there is increasing evidence that SDM has improved overall care provided to patients with psychiatric illnesses [5]. For instance, a randomized study proved that SDM played major role in improving the 2-year outcome in schizophrenic patients by augmenting social recovery and by providing opportunity for individual empowerment in health care decision making as compared with control group [6]. In addition, involving patients in SDM is an impor- tant ethical responsibility for health care providers and should be offered to all subsets of patients, regardless of their Presenting complaints and set- tings of care. More often than not, the ED remains the patient’s first interface with a health care provider. Physicians in the ED should take this opportu- nity to embark on the process of patient-centered care using SDM tools. Therefore, we believe that an attempt should be made to include all patients in SDM regardless of the (psychologic condition) presenting to the ED.

    ? Funding: None.

    842 Correspondence / American Journal of Emergency Medicine 33 (2015) 834-855

    We would appreciate authors’ response.

    Vinod K. Chaubey, MD? Nirmal J. Kaur, MD

    possibility of misdiagnosis of this entity. We have diagnosed 3 cases of HBSE in our institution in the last year. Our cases were re- markably similar in their clinical and radiologic presentation, with patients observed for the first time in the emergency department

    Department of Medicine, Saint Vincent Hospital, Worcester, MA, USA

    ?Corresponding author. Department of Medicine, Saint Vincent Hospital

    123 Summer St, Worcester, MA, 01608, USA Tel.: +1 508 363 5000; fax: +1 508 363 9798

    E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2015.03.012

    References

    Reschke Daniel J, Seeskin Zachary H, Hahn Elizabeth A, Pang Peter S. patient preferences regarding medical decision-making in the Emergency care setting: a pilot-study. Am J Emerg Med 2015. http://dx.doi.org/10.1016/j.ajem.2015.01.058.

17. Lee Emily Oshima, Emanuel Ezekiel J. Shared decision making to improve care and reduce costs. N Engl J Med 2013;368:6-8.
18. Flynn D, Knoedler MA, Hess EP, Murad MH, Erwin PJ, et al. Engaging patients in health Care decisions in the emergency department through shared decision-making: a systematic review. Acad Emerg Med 2012;19(8):959-67.
19. Fukui S, Salyers MP, Matthias MS, Collins L, Thompson J, et al. Predictors of shared decision making and level of agreement between consumers and providers in psychiatric care. Community Ment Health J 2014;50(4):375-82.
20. Adams JR, Drake RE, Wolford GL. Shared decision-making preferences of people with severe Mental illness. Psychiatr Serv 2007;58(9):1219-21.
21. Hamann J, Langer B, Winkler V, Busch R, Cohen R, et al. Shared decision making for in- patients with schizophrenia. Acta Psychiatr Scand 2006;114(4):265-73.

    How rare is Hypertensive brain stem encephalopathy??

    

    To the Editor,

    Liao et al [1] presented a case of hypertensive brain stem encephalop- athy (HBSE), a rarely reported central variant of posterior reversible en- cephalopathy syndrome. We would like to acknowledge the authors for the diagnosis and concise discussion. The authors also highlighted the

    because of headache in the context of acute severe elevation of blood pressure (values N 170/100 mm Hg in all). We are in agreement with Liao et al [1] regarding the radiologic findings pointing to the diagnosis of HBSE in the appropriate context. However, radiologists and emer- gency physicians may not be aware of this entity, particularly if the typical supratentorial parieto-occipital changes of posterior reversible encephalopathy syndrome are absent. In our patients, the diagnosis of HBSE was not initially considered. Relatively more common diagnosis such as rhombencephalitis or brainstem glioma was firstly considered, leading to extensive investigation in 1 case [2] and unnecessary treat- ment with radiation and chemotherapy (temozolamide) in 2 pa- tients in whom the diagnosis of diffuse brainstem glioma was initially considered (Figure, illustrative case). It is reasonable to admit the possibility of underdiagnosed of HBSE. Thus, highlighting the HBSE signature, the presence of clinical-radiologic dissociation is ex- tremely important. Patients with HBSE, despite the presence of extensive diffuse brainstem lesion, generally manifest minimal brainstem neurolog- ic signs or symptoms [2-4]. Indeed, the clinical-radiologic dissociation characteristic of HBSE is totally unexpected in any of the differential di- agnosis of diffuse brainstem lesion. Because biopsy of the brainstem is not universally performed for the confirmation of the vast majority of diagnosis, in similar cases, progressive reduction of blood pressure and repeated imaging after a week are sufficient to clarify the diagnosis.

    Catarina Felix, MD Department of Neurology, Centro Hospitalar do Algarve, Faro, Portugal stroke unit, Centro Hospitalar do Algarve, Faro, Portugal

    Nadia Fernandes, MD Stroke Unit, Centro Hospitalar do Algarve, Faro, Portugal Department of Internal Medicine, Centro Hospitalar do Algarve

    Faro, Portugal

    

    Figure. Typical radiologic findings of HBSE. brain computed tomography showing hypodensity in the pons (a and b); initial brain magnetic resonance imaging (MRI) (c-i) showing hyperintense bulbo-ponto-mesencephalic sign on fluid attenuation inversion recovery (c-f), normal sign on diffusion weighted imaging (g), weighted and apparent diffusion coefficient map (h), and hyperintese sign on coronal T2 MRI (i); and follow-up brain MRI (j-i) showing resolution of the imaging findings coronal T2 (j) and fluid attenuation inversion recovery (k and l).

    ? Disclosure: The authors have nothing to disclose.