scholarly journals Traumatic hollow viscus and mesenteric injury: role of CT and potential diagnostic–therapeutic algorithm

2020 ◽  
Author(s):  
Alessandro Michele Bonomi ◽  
Stefano Granieri ◽  
Shailvi Gupta ◽  
Michele Altomare ◽  
Stefano Piero Bernardo Cioffi ◽  
...  
Keyword(s):  
Trauma Patients ◽  
Complication Rates ◽  
Likelihood Ratios ◽  
Hollow Viscus ◽  
Predictive Values ◽  
Mesenteric Injury ◽  
Contrast Enhanced Ct ◽  
Death Probability ◽  
Urban Level ◽  
Cect Scan

AbstractDespite its rarity, traumatic hollow viscus and mesenteric injury (HVMI) have high mortality and complication rates. There is no consensus regarding its best management. Our aim is to evaluate contrast enhanced CT (ceCT) in the screening of HVMI and its capability to assess the need for surgery. All trauma patients admitted to an urban Level 1 trauma center between 2010 and 2018 were retrospectively evaluated. Patients with ceCT scan prior to laparotomy were included. Patients requiring surgical repair of HVMI and a ceCT scan consistent with HVMI were considered true positives. Six ceCT scan criteria for HVMI were used; at least one criterion was considered positive for HVMI. Sensitivity (Sn), specificity (Sp), predictive values (PV), likelihood ratios (LR) and accuracy (Ac) of ceCT of single ceCT criteria and of the association of ceCT criteria were calculated using intraoperative findings as gold standard. Therapeutic time (TT), death probability (DP), and observed mortality (OM) were described. 114 of 4369 patients were selected for ceCT accuracy analysis; 47 were considered true positives. Sn of ceCT for HVMI was 97.9%, Sp 63.6%, PPV 66.2%, NPV 97.6%, + LR 2.69, −LR 0.03, Ac 78%; no single criterion stood out. The association of four or more criteria improved ceCT Sp to 98.5%, PPV to 95.6%, + LR to 30.5. Median TT was 2 h (IQR: 1–3 h). OM was 7.8%—not significantly higher than overall OM. CeCT in trauma has become a reliable screening test for HVMI and a valid exam to select HVMI patients for surgical exploration.

Percutaneous Tracheostomy under Bronchoscopic Visualization Does Not Affect Short-Term or Long-Term Complications

2017 ◽  
Vol 83 (7) ◽  
pp. 696-698 ◽  
Author(s):  
Thomas S. Easterday ◽  
Joshuaw Moore ◽  
Meredith H. Redden ◽  
David V. Feliciano ◽  
Vernon J. Henderson ◽  
...  
Keyword(s):  
Trauma Registry ◽  
Percutaneous Tracheostomy ◽  
Trauma Patients ◽  
Complication Rates ◽  
Short Term ◽  
Significant Difference ◽  
Urban Level ◽  
Level I ◽  
Bronchoscopic Guidance

Percutaneous tracheostomy is a safe and effective bedside procedure. Some advocate the use of bronchoscopy during the procedure to reduce the rate of complications. We evaluated our complication rate in trauma patients undergoing percutaneous tracheostomy with and without bronchoscopic guidance to ascertain if there was a difference in the rate of complications. A retrospective review of all tracheostomies performed in critically ill trauma patients was performed using the trauma registry from an urban, Level I Trauma Center. Bronchoscopy assistance was used based on surgeon preference. Standard statistical methodology was used to determine if there was a difference in complication rates for procedures performed with and without the bronchoscope. From January 2007, to April 2016, 649 patients underwent modified percuteaneous tracheostomy; 289 with the aid of a bronchoscope and 360 without. There were no statistically significant differences in any type of complication regardless of utilization of a bronchoscope. The addition of bronchoscopy provides several theoretical benefits when performing percutaneous tracheostomy. Our findings, however, do not demonstrate a statistically significant difference in complications between procedures performed with and without a bronchoscope. Use of the bronchoscope should, therefore, be left to the discretion of the performing physician.

scholarly journals POS1418 REALIZING EARLY RECOGNITION OF ARTHRITIS IN TIMES OF INCREASED TELEMEDICINE: THE VALUE OF PATIENT-REPORTED SWOLLEN JOINTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 992.1-992
Author(s):  
C. Rogier ◽  
B. Van Dijk ◽  
E. Brouwer ◽  
P. De Jong ◽  
A. Van der Helm - van Mil
Keyword(s):  
Early Recognition ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Self Report ◽  
Symptom Duration ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Patient Level ◽  
Patient Reported ◽  
Joint Examination

Background:Early diagnosis and management of patients with inflammatory arthritis(IA) are critical to improve long-term patient-outcomes. Assessment of joint swelling at joint examination is the reference of IA-identification; early access clinics are constructed to promote this early recognition of IA. However, due to the COVID-19 pandemic the face-to-face capacity of such services is severely reduced. The accuracy of patient-reported swelling in comparison to joint examination has been extensively evaluated in established RA (ρ 0.31-0.67), but not in patients suspected for IA.[1]Objectives:To promote evidence based care in the era of telemedicine, we determined the accuracy of patient-reported joint swelling for actual presence of IA in persons suspected of IA by general practitioners(GP).Methods:Data from two Dutch Early Arthritis Recognition Clinics were studied. These are screening clinics (1.5-lines-setting) where GPs send patients in case of doubt on IA. At this clinic patients were asked to mark the presence of swollen joints on a mannequin with 52 joints. For this study the DIP joints and the metatarsal joints were excluded and, therefore, a total of 42 joints were assessed for self-reported joint swelling. Clinically apparent IA of ≥1 joint determined by the physician was the reference to calculate sensitivity, specificity, positive and negative likelihood ratios (LR+,LR-), and positive and negative predictive values (PPV, NPV) on patient-level. Pearson correlation coefficients(ρ) were determined. Predictive values depend on the prevalence of a disease in a population. Because the prevalence of IA in a 1.5-lines-setting will differ from a primary care setting, post-test probabilities of IA were estimated for two lower prior-test probabilities as example, namely 20% (estimated probability in patients GPs belief IA is likely) and 2% (prior-test probability with less preselection by GPs), using likelihood ratios and nomograms.Results:A total of 1637 consecutive patients were studied. Median symptom duration was 13 weeks. 76% of patients marked ≥1swollen joint at the mannequin. 41% of patients had ≥1swollen joint at examination by rheumatologists. ρ was 0.20(patient-level)-0.26(joint-level).The sensitivity of patients-reported joint swelling was high, 87%, indicating that the majority of patients with IA had marked swelling on the mannequin. However the specificity was 31%, indicating that 69% of persons without IA had also done so. The LR+ was 1.25; the LR- 0.43. The PPV was 46%, the NPV 77%. Thus the PPV increased hardly (from 41% to 46%) and the NPV somewhat (from 59% to 77%). Also in settings with prior-test probabilities of 20% and 2%, estimated PPVs (from respectively 20% and 2% to 24% and 2%) and NPVs (from respectively 80% and 98% to 90% and 99%) hardly increased.Conclusion:Patient-reported joint swelling had little value in distinguishing patients with/without IA for different prior-test probabilities, and is less valuable in comparison to self-reported flare detection in established RA.References:[1]Barton JL, Criswell LA, Kaiser R, et al. Systematic review and metaanalysis of patient self-report versus trained assessor joint counts in rheumatoid arthritis. J Rheumatol 2009;36:2635-2641.Disclosure of Interests:None declared

Intraperitoneal Urinary Bladder Rupture as a Cause of Pneumoperitoneum

2021 ◽  
pp. 000313482110257
Author(s):  
Dar Parvez M ◽  
Kour Supreet ◽  
Sharma Ajay ◽  
Kumar Subodh
Keyword(s):  
Urinary Bladder ◽  
Primary Repair ◽  
Exploratory Laparotomy ◽  
Pelvic Trauma ◽  
Bladder Rupture ◽  
Abdominal Pressure ◽  
Trauma Patients ◽  
Hollow Viscus ◽  
Sudden Rise ◽  
Intraperitoneal Bladder Rupture

The most common cause of pneumoperitoneum in trauma patients is hollow viscus injury; however, in patients with pneumoperitoneum on imaging and normal hollow viscus during the laparotomy, other rare causes of pneumoperitoneum like intraperitoneal urinary bladder rupture should be ruled out. Urinary bladder can rupture either extraperitoneally or intraperitoneally or both. Rupture of the urinary bladder is commonly seen in patients with abdominal trauma; however, pneumoperitoneum is usually not seen in patients with traumatic bladder rupture. Intraperitoneal bladder rupture is usually due to the sudden rise in intra-abdominal pressure following abdominal or pelvic trauma. However, it is a rare cause of pneumoperitoneum and is managed by surgical repair. We present a case of blunt trauma abdomen with pneumoperitoneum due to isolated intraperitoneal bladder rupture who was managed by exploratory laparotomy and primary repair of the urinary bladder.

scholarly journals Sonographic Assessment of Complex Ultrasound Morphology in Pregnant Women with the Use of IOTA Simple Rules Risk and ADNEX Scoring Systems

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 414
Author(s):  
Artur Czekierdowski ◽  
Norbert Stachowicz ◽  
Agata Smoleń ◽  
Tomasz Kluz ◽  
Tomasz Łoziński ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Risk Model ◽  
Malignant Tumors ◽  
Scoring Systems ◽  
Subjective Assessment ◽  
Risk Level ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Adnexal Masses ◽  
Simple Rules

Background: To evaluate the accuracy of subjective assessment (SA), the International Ovarian Tumor Analysis (IOTA) group Simple Rules Risk (SRR) and the Assessment of Different NEoplasias in the adneXa (ADNEX) model for the preoperative differentiation of adnexal masses in pregnant women. Methods: The study population comprised 36 pregnant women (median age: 28.5 years old, range: 20–42 years old) with a mean gestation age of 13.5 (range: 8–31) weeks at diagnosis. Tumors were prospectively classified by local sonographers as probably benign or probably malignant using SA. Final tumor histological diagnosis was used as the reference standard in all cases. Logistic regression SRR and ADNEX models were used to obtain a risk score for every case. Serum CA125 and human epidydimis protein 4 (HE4) concentrations were also retrieved and the Risk of Ovarian Malignancy Algorithm (ROMA) value was calculated. The calculated predictive values included positive and negative likelihood ratios of ultrasound and biochemical tests. Results: Final histology confirmed 27 benign and 9 malignant (including 2 borderline) masses. The highest sensitivity (89%) and specificity (70%) were found for the subjective tumor assessment. Although no malignancy was classified as benign using the SRR criteria (sensitivity = 100%), the specificity of this scoring system was only 37%. At the cut-off risk level of >20%, the ADNEX model had a sensitivity of 78% and a specificity of 70%. Serum levels of CA125, HE4 and the ROMA risk model correctly identified adnexal malignant tumors with a sensitivity of 67%, 25% and 25%, respectively. Corresponding specificities were 72%, 100% and 100%, respectively. The highest positive and negative likelihood ratios were found for SA (LR+ = 3.0 and LR− = 0.16, respectively). Overall diagnostic accuracy of all predictive methods used in this study were similar (range: 70–75%) except for SRR (53%). Conclusion: Subjective assessment remains the best predictive method in complex adnexal masses found at prenatal ultrasound in pregnant women. For less experienced sonographers, both the SRR and ADNEX scoring systems may be also used for the characterization of such tumors, while serum tumor markers CA125 and HE4, along with the ROMA algorithm appear to be less accurate.

scholarly journals Usefulness of Pelvic Radiographs in the Initial Trauma Evaluation with Concurrent CT: Is Additional Radiation Exposure Necessary?

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Anne K. Misiura ◽  
Autumn D. Nanassy ◽  
Jacqueline Urbine
Keyword(s):  
Trauma Center ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Additional Information ◽  
Pelvic Radiographs ◽  
Pelvic Radiograph ◽  
Digital Radiograph ◽  
Urban Level ◽  
Level I ◽  
Pediatric Trauma Center

Trauma patients in a Level I Pediatric Trauma Center may undergo CT of the abdomen and pelvis with concurrent radiograph during initial evaluation in an attempt to diagnose injury. To determine if plain digital radiograph of the pelvis adds additional information in the initial trauma evaluation when CT of the abdomen and pelvis is also performed, trauma patients who presented to an urban Level I Pediatric Trauma Center between 1 January 2010 and 7 February 2017 in whom pelvic radiograph and CT of the abdomen and pelvis were performed within 24 hours of each other were analyzed. A total of 172 trauma patients had pelvic radiograph and CT exams performed within 24 hours of each other. There were 12 cases in which the radiograph missed pelvic fractures seen on CT and 2 cases in which the radiograph suspected a fracture that was not present on subsequent CT. Furthermore, fractures in the pelvis were missed on pelvic radiographs in 12 of 35 cases identified on CT. Sensitivity of pelvic radiograph in detecting fractures seen on CT was 65.7% with a 95% confidence interval of 47.79-80.87%. Results suggest that there is no added diagnostic information gained from a pelvic radiograph when concurrent CT is also obtained, a practice which exposes the pediatric trauma patient to unnecessary radiation.

scholarly journals Value and Diagnostic Efficacy of Fetal Morphology Assessment Using Ultrasound in A Poor-Resource Setting

Diagnostics ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 109 ◽  
Author(s):  
Ukweh ◽  
Ugbem ◽  
Okeke ◽  
Ekpo
Keyword(s):  
Predictive Value ◽  
Performance Metrics ◽  
Area Under The Curve ◽  
Youden Index ◽  
Likelihood Ratios ◽  
Diagnostic Efficacy ◽  
Predictive Values ◽  
Resource Setting ◽  
Post Test ◽  
Sensitivity Specificity

Background: Ultrasound is operator-dependent, and its value and efficacy in fetal morphology assessment in a low-resource setting is poorly understood. We assessed the value and efficacy of fetal morphology ultrasound assessment in a Nigerian setting. Materials and Methods: We surveyed fetal morphology ultrasound performed across five facilities and followed-up each fetus to ascertain the outcome. Fetuses were surveyed in the second trimester (18th–22nd weeks) using the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. Clinical and surgical reports were used as references to assess the diagnostic efficacy of ultrasound in livebirths, and autopsy reports to confirm anomalies in terminated pregnancies, spontaneous abortions, intrauterine fetal deaths, and still births. We calculated sensitivity, specificity, positive and negative predictive values, Area under the curve (AUC), Youden index, likelihood ratios, and post-test probabilities. Results: In total, 6520 fetuses of women aged 15–46 years (mean = 31.7 years) were surveyed. The overall sensitivity, specificity, and AUC were 77.1 (95% CI: 68–84.6), 99.5 (95% CI: 99.3–99.7), and 88.3 (95% CI: 83.7–92.2), respectively. Other performance metrics were: positive predictive value, 72.4 (95% CI: 64.7–79.0), negative predictive value, 99.6 (95% CI: 99.5–99.7), and Youden index (77.1%). Abnormality prevalence was 1.67% (95% CI: 1.37–2.01), and the positive and negative likelihood ratios were 254 (95% CI: 107.7–221.4) and 0.23 (95% CI: 0.16–0.33), respectively. The post-test probability for positive test was 72% (95% CI: 65–79). Conclusion: Fetal morphology assessment is valuable in a poor economics setting, however, the variation in the diagnostic efficacy across facilities and the limitations associated with the detection of circulatory system anomalies need to be addressed.

Feasibility and safety of percutaneous computed tomography guided radiofrequency ablation of lymph nodes in oligometastatic patients: a single center’s experience

2021 ◽  
Vol 94 (1121) ◽  
pp. 20200445
Author(s):  
Dimitrios Filippiadis ◽  
George Charalampopoulos ◽  
Athanasios Tsochatzis ◽  
Lazaros Reppas ◽  
Argyro Mazioti ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Lymph Nodes ◽  
Clinical Success ◽  
Complete Response ◽  
Tumor Control ◽  
Complication Rates ◽  
Ct Guided ◽  
Female Ratio ◽  
Contrast Enhanced Ct ◽  
The Mean

Objectives: To retrospectively evaluate feasibility and safety of CT-guided percutaneous radiofrequency ablation (RFA) of metastatic lymph nodes (LN) in terms of achieving local tumor control. Methods: Institutional database research identified 16 patients with 24 metastatic LNs who underwent percutaneous CT-guided radiofrequency ablation. Mean patient age was 66.6 ± 15.70 years (range 40–87) and male/female ratio was 8/8. Contrast-enhanced CT or MRI was used for post-ablation follow-up. Patient and tumor characteristics and RFA technique were evaluated. Technical and clinical success on per tumor and per patient basis as well as complication rates were recorded. Results: Mean size of the treated nodes was 1.78 ± 0.83 cm. The mean number of tumors per patient was 1.5 ± 0.63. The mean procedure time was 56.29 ± 24.27 min including local anesthesia, electrode(s) placement, ablation and post-procedural CT evaluation. Median length of hospital stay was 1.13 ± 0.34 days. On a per lesion basis, the overall complete response post-ablation according to the mRECIST criteria applied was 75% (18/24) of evaluable tumors. Repeat treatment of an index tumor was performed on two patients (three lesions) with complete response achieved in 87.5% (21/24) of evaluable tumors following a second RFA. On a per patient basis, disease progression was noted in 10/16 patients at a mean of 13.9 ± 6.03 months post the ablation procedure. Conclusion: CT-guided percutaneous RFA for oligometastatic LNs is a safe and feasible therapy. Advances in knowledge: With this percutaneous therapeutic option, metastatic LNs can be eradicated with a very low complication rate.

Symptoms are the Most Effective Child SCAT5 Component for Recognizing Concussion on the Day of Injury

2021 ◽  
Author(s):  
Nicholas Kevin Erdman ◽  
Patricia M. Kelshaw ◽  
Samantha L. Hacherl ◽  
Shane V. Caswell
Keyword(s):  
Middle School ◽  
Diagnostic Accuracy ◽  
School Children ◽  
Assessment Tool ◽  
Diagnostic Odds Ratio ◽  
Likelihood Ratios ◽  
Middle School Children ◽  
Predictive Values ◽  
Symptom Evaluation ◽  
Diagnostic Properties

Abstract Background: The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) was developed to evaluate children between 5-12 years of age for a suspected concussion. However, limited empirical evidence exists demonstrating the value of the Child SCAT5 for acute concussion assessment. Therefore, the purpose of our study was to examine differences and assess the diagnostic properties of Child SCAT5 scores among concussed and non-concussed middle school children on the same day as a suspected concussion.Methods: Our participants included 34 concussed (21 boys, 13 girls; age=12.8±0.86 years) and 44 non-concussed (31 boys, 13 girls; age=12.4±0.76 years) middle school children who were administered the Child SCAT5 upon suspicion of a concussion. Child SCAT5 scores were calculated from the symptom evaluation (total symptoms, total severity), child version of the Standardized Assessment of Concussion (SAC-C), and modified Balance Error Scoring System (mBESS). The Child SCAT5 scores were compared between the concussed and non-concussed groups. Non-parametric effect sizes (r=z/√n) were calculated to assess the magnitude of difference for each comparison. The diagnostic properties (sensitivity, specificity, diagnostic accuracy, predictive values, likelihood ratios, and diagnostic odds ratio) of each Child SCAT5 score were also calculated.Results: Concussed children endorsed more symptoms (p<0.001, r=0.45), higher symptom severity (p<0.001, r=0.44), and had higher double leg (p=0.046, r=0.23), single leg (p=0.035, r=0.24), and total scores (p=0.022, r=0.26) for the mBESS than non-concussed children. No significant differences were observed for the SAC-C scores (p’s≥0.542). The quantity and severity of endorsed symptoms had the best diagnostic accuracy (AUC=0.76–0.77), negative predictive values (NPV=0.84–0.88), and negative likelihood ratios (-LR=0.22–0.31) of the Child SCAT5 scores.Conclusions: The symptom evaluation was the most effective component of the Child SCAT5 for differentiating between concussed and non-concussed middle school children on the same day as a suspected concussion.

Comparison of the diagnostic performances of the Assessment of Different NEoplasias in the adneXa model, Simple Rules model, and Risk of Malignancy Index for adnexal masses in a gynecological oncology centre  in China

2020 ◽  
Author(s):  
Le Qian ◽  
Qinwen Du ◽  
Meijiao Jiang ◽  
Fei Yuan ◽  
Hui Chen ◽  
...  
Keyword(s):  
Prediction Models ◽  
Roc Curves ◽  
Chinese Patients ◽  
Malignant Tumours ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Adnexal Masses ◽  
Simple Rules ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index

Abstract Background This study aimed to compare different ultrasound-based International Ovarian Tumor Analysis (IOTA) prediction models, namely, the Simple Rules (SRs) the Assessment of Different NEoplasias in the adneXa (ADNEX) models, and the Risk of Malignancy Index (RMI), for the pre-operative diagnosis of adnexal mass. Methods This single-centre, retrospective study of diagnostic accuracy involved 486 patients. All ultrasound examinations were analyzed and the prediction models were applied. Pathology was the clinical reference standard. The diagnostic performances of prediction models were measured by evaluating receiver-operating characteristic (ROC) curves, sensitivities, specificities, positive and negative predictive values, positive and negative likelihood ratios, and diagnostic odds ratios. Results To discriminate benign and malignant tumours, areas under the ROC curves (AUCs) for ADNEX models were 0.94 (95% CI: 0.92–0.96) with CA125 and 0.94 (95% CI: 0.91–0.96) without CA125, which were significantly higher than the AUCs for RMI I-III: 0.87 (95% CI: 0.83–0.90), 0.83 (95% CI: 0.80–0.86), and 0.82 (95% CI: 0.78–0.86), (all P < 0.0001). At a cut-off of 10%, the ADNEX model with CA125 had the highest sensitivity (0.93; 95% CI: 0.87–0.97) compared with the other models. The SRs model achieved a sensitivity of 0.93 (95% CI: 0.86–0.97) and a specificity of 0.86 (95% CI: 0.82–0.89) when inconclusive diagnoses (11.7%) were classified as malignant. Conclusion ADNEX and SRs models were excellent at characterising adnexal masses which were superior to the RMI in Chinese patients.

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