Journal of Urgent Care Medicine

Imaging Ranks As Top Service Among Outpatient Visits

Nationally, imaging accounted for 24% of all outpatient visits and 17% of outpatient spending in 2022, according to a new issue brief from the Health Care Cost Institute (HCCI). Only diagnostic testing and labs accounted for a larger proportion of outpatient visits by category (31%). Mammography and chest x-rays are the most common among imaging services. In terms of reimbursement, commercial payment for imaging is higher than what Medicare pays, with commercial reimbursement averaging 245–314% …

Deepfake X-Rays Could Be Hard To Spot

A new study in Radiology evaluated whether radiologists in 6 different countries could distinguish AI-generated (“deepfake”) radiographs from real images. In a subsequent phase of the study, 4 large language models (LLMs) were also tasked with deciding which images were authentic and which were deepfakes. Among 17 practicing radiologists, only 41% recognized AI-generated images as having poor technical quality at first look (“Did you notice anything unusual about these images?”). After learning that some images …

Proposed X-Ray Rules Heighten Radiation Protection Standards

Newly proposed legislation in Arizona aims to regulate radiation safety beyond the current federal and state standards, according to AZ Mirror. Proponents say the package represents a first-in-the-nation push focused on “radiation protection systems” for interventional x-ray. For example, it requires hospitals performing real-time x-ray procedures to install enhanced protection systems in at least 50% of their procedure rooms by July 2027, and the system must include shielding that offers protection equivalent to or better …

11-year-old With Heel Pain While Running

An 11-year-old male presents to urgent care complaining of bilateral heel pain, right worse than left. The patient denies recent trauma and reports experiencing increased pain when running. He has not tried any treatment and denies any history of similar episodes in the past. Physical examination reveals bilateral pes planus and decreased dorsiflexion of the feet with weightbearing lunge against the wall. Pain is elicited with calcaneal compression test. The patient is noted to be …

Urgent Care Evaluation and Management of Suspected Lisfranc Injuries

Urgent Message: Rapid identification of Lisfranc injuries in urgent care is critical, as delays in diagnosis can lead to chronic disability. Most patients with Lisfranc fractures or dislocations should be referred directly to the emergency department. Cross-sectional imaging (ie, computed tomography) and orthopedic consultation are time-sensitive, and urgent operative repair is often indicated. Alexandra Eby, BS; Nicole Meschbach, MD Questions for the Urgent Care Clinician at the Bedside Abstract A Lisfranc injury is a tarsometatarsal …

51-Year-Old With Hemoptysis

A 51-year-old man presents to urgent care complaining of night sweats and a productive cough with visible blood for the past 2 weeks. He says he’s been feeling rather tired lately. A chest x-ray is ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.

Ohio X-Ray Regulations Shackle Urgent Care Growth

Most of the legislative issues that affect urgent care operations are governed at the state level, particularly provider scope-of-practice laws. A recent guest column in the Columbus Dispatch by Alan Ayers, MBA, MAcc, President of Urgent Care Consultants and Senior Editor of JUCM, makes the case for urgent care’s untapped potential in providing affordable access to care in rural areas. Kentucky and Indiana are witnessing growth in rural urgent care, but Ohio is lagging because …

7-Year-Old With Playground Injury

A 7-year-old boy presents to urgent care with his worried mother after he fell off a swing at daycare. He is complaining of right foot pain and can’t walk on the injured foot. Anterior posterior and oblique foot x-rays are ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.

Abstracts in Urgent Care – December 2024

ECG Interpretation: Humans Vs Machines Take Home Point: In this study, cardiologists and emergency physicians (EP) had greater accuracy for electrocardiogram (ECG) interpretation than current versions of ChatGPT and Gemini. Citation: Günay S, Öztürk A, Yiğit Y. The accuracy of Gemini, GPT-4, and GPT-4o in ECG analysis: A comparison with cardiologists and emergency medicine specialists. Am J Emerg Med. 2024 Oct:84:68-73. doi: 10.1016/j.ajem.2024.07.043. Relevance: Artificial Intelligence (AI) is rapidly evolving and becoming an integral part …

Urgent Care Diagnosis and Management of Midshaft Ulnar (Nightstick) Fractures

Urgent Message: Fractures of the midshaft ulna, commonly referred to as “nightstick fractures,” typically occur after direct injury to a forearm outstretched above the head as a protective mechanism. Evaluation includes inquiry into the circumstances of the assault, assessment for any other areas of trauma, examination of the skin, wrist and elbow joints, and radiography of the forearm. Management of closed, nondisplaced midshaft ulnar fractures centers around splint immobilization and arrangement of appropriate follow-up. Chandrika …

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