vehicle, motorcycle crash, highway crash           victim thrown from vehicle, death of fellow passenger           case involving a difficult rescue, sideslip of the vehicle, etc.            2> fall (3 m)            3> crushed under heavy Luminespib chemical structure object            4> other high energy mechanisms   #4  Case that requires invasive EGFR inhibitor emergency treatment

necessitating movement to other rooms            1> case that requires an emergency operation            2> case that requires emergency angiography (embolization)            3> other invasive treatment required Action If patient‘s condition agrees to one of above criteria at least, EP should take action as follows            1) EP should actively employ enhanced CT for chest, abdomen and pelvis if possible.            2) EP should re-interpret emergency CT more than twice after a short interval.            3) EP should

change window level according to organs to interpret.            4) EP should evaluate not only in an axial view but also in a sagittal view or coronal view if needed.            5) EP should actively evaluate bone injuries using three-dimensional Selleck GSK2126458 view.            6) EP should repeat CT after time has passed if there are unclear points. Additional advice If there problems as follows, EP should

consider real-time consultation with a radiologist            1) Patient’s physiological condition Olopatadine deteriorates in spite of treatments.            2) Data of laboratory findings show development of anemia or metabolic acidosis in spite of treatments.            3) Unclear points remain in spite of re-interpretation CT or repetition of CT. We established a new precautionary rule for the interpretation of emergency CT scans in cases of blunt trauma. This study comprised two periods. In the first period (before introduction of the rule), the records of CT interpretations in ED blunt trauma cases during January 2011 and June 2012 were reviewed, and the accuracy of the EPs’ interpretations as well as resulting patient outcomes were investigated. In the second period (after introduction of the rule), the accuracy of the EPs’ CT interpretations and the resulting patient outcomes were investigated for July 2012 and January 2013. Finally, we evaluated whether our rule was effective by comparing the accuracy of the EPs’ interpretations and patient outcomes both before and after implementation of the rule. In both periods, the interpretation accuracy was evaluated by comparing the initial interpretation recorded by the EP and the definitive diagnosis.