P5676Implementing a syncope pathway

Abstract Background Syncope is a common presenting symptom in emergency departments (0.8–2.4%) and is associated with high health care costs. In up to 40% of cases, etiology remains unidentified after initial evaluation. Purpose To assess the increase in diagnostic yield and the time to diagnosis by implementing a structured pathway in syncope evaluation according ESC- Guidelines in a secondary hospital. Methods In the study, we compared 2 groups of patients with T-LOC. We evaluated the diagnostic yield and the time to diagnosis. The first group comprised all patients with T-LOC referred to the emergency department (ED) of the hospital from January to March 2016. The work-up was done according to existing clinical practice. After implementation of a structured pathway in syncope evaluation according to ESC-Guidelines, we reevaluated the diagnostic yield and the time to diagnosis in all patients referred to ED with T-LOC from July to September 2017. The implementation consisted of an initial evaluation (careful history taking with a checklist, physical examination, ECG, orthostatic challenge test carried out by nurses), risk assessment and instructing the medical staff. Results There were 169 vs. 85 patients presenting with suspected T-LOC in the ED. 130 (77%) vs. 65 (76.5%) were classified as having a syncope. The diagnostic yield in the syncope patients was 60% vs. 80% (p=0.013). The rate of correct diagnosis within 14 days increased from 55 to 80%. Conclusion By implementing a structured pathway and educating the staff, we succeeded in increasing diagnostic yield from 60 to 80%. This could be achieved in a reduced referral to diagnosis time.

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Practicability and Diagnostic Yield of One-Stop Stroke CT with Delayed-Phase Cardiac CT in Detecting Major Cardioembolic Sources of Acute Ischemic Stroke

Clinical Neuroradiology ◽

10.1007/s00062-021-01003-7 ◽

2021 ◽

Author(s):

Friederike Austein ◽

Matthias Eden ◽

Jakob Engel ◽

Annett Lebenatus ◽

Naomi Larsen ◽

...

Keyword(s):

Diagnostic Yield ◽

Early Stage ◽

Recurrent Stroke ◽

Cardiac Computed Tomography ◽

Standard Of Care ◽

Routine Work ◽

One Stop ◽

Work Up ◽

Delayed Phase ◽

Multimodal Ct

Abstract Purpose Recurrent stroke is considered to increase the incidence of severe disability and death. For correct risk assessment and patient management it is essential to identify the origin of stroke at an early stage. Transthoracic echocardiography (TTE) is the initial standard of care for evaluating patients in whom a cardioembolic source of stroke (CES) is suspected but its diagnostic capability is limited. Transesophageal echocardiography (TEE) is considered as gold standard; however, this approach is time consuming, semi-invasive and not always feasible. We hypothesized that adding a delayed-phase cardiac computed tomography (cCT) to initial multimodal CT might represent a valid alternative to routine clinical echocardiographic work-up. Material and Methods Patients with suspected acute cardioembolic stroke verified by initial multimodal CT and subsequently examined with cCT were included. The cCT was evaluated for presence of major CES and compared to routine clinical echocardiographic work-up. Results In all, 102 patients with suspected acute CES underwent cCT. Among them 60 patients underwent routine work-up with echocardiography (50 TTE and only 10 TEE). By cCT 10/60 (16.7%) major CES were detected but only 4 (6.7%) were identified by echocardiography. All CES observed by echocardiography were also detected by cCT. In 8 of 36 patients in whom echocardiography was not performed cCT also revealed a major CES. Conclusion These preliminary results show the potential diagnostic yield of delayed-phase cCT to detect major CES and therefore could accelerate decision-making to prevent recurrence stroke. To confirm these results larger studies with TEE as the reference standard and also compared to TTE would be necessary.

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Abstract 2928: Sudden Arrhythmic Death Syndrome-Diagnostic Yield Of Combined Clinical & Genetic Screening In A British Specialist Clinic

Circulation ◽

10.1161/circ.116.suppl_16.ii_653-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Pier D Lambiase ◽

Juan C Kaski ◽

Eileen Firman ◽

Perry M Elliott ◽

Akbar K Ahmed ◽

...

Keyword(s):

Heart Disease ◽

Genetic Testing ◽

Screening Programme ◽

Diagnostic Yield ◽

Challenge Test ◽

Structural Heart Disease ◽

Clinical Screening ◽

Arrhythmic Death ◽

Sudden Arrhythmic Death Syndrome ◽

Index Cases

Introduction: Sudden arrhythmic death syndrome (SADS) arises through disorders of ion channel function or structural heart disease. It accounts for over 400 deaths in the UK per annum. To date there has been no comprehensive analysis of the diagnostic yield and efficacy of a family screening approach in SADS index cases where the post mortem heart is structurally normal after expert pathological review. Methods: 118 SADS families where the SADS victim died between 1 and 35 years of age were evaluated in a systematic family screening programme between 2003–2006. All SADS index cases had a structurally normal heart after expert review of all available tissue. All studied relatives underwent resting, signal averaged ECG, 24h Holter, exercise ECG with V0 2 max, transthoracic echocardiography and an ajmaline challenge test after initial clinical screening. Systematic mutation analysis was performed on the known long QT (LQT)genes including SCN5A & ryanodine receptor/ARVC genes when clinically suspected. Results: The most common modes of death were rest in 28%, sleep in 25% and exercise in 18%. Clinical screening identified an inherited electrical cause of SADS in 41 of the 118 families (35%)-20 Brugada, 18 LQT Syndrome, 3 Catecholiminergic Polymorphic Ventricular Tachycardia (CPVT). Structural heart disease was identified in 5 ARVC & 2 DCM families. 26 ICDs have been implanted in affected family members-4 LQTS, 7 Brugada, 2 CPVT, 2 ARVC, 2 DCM and 9 on clinical grounds without a definitive diagnosis. The ECG (37%) and ajmaline challenge test (49%) had the highest diagnostic yield in families with a positive diagnosis. To date, genetic testing has increased the diagnostic yield by 5% (6/118 families-2 KCNQ1, 1 HERG, 2 SCN5A, 1 ARVC ), confirming a clinical diagnosis in 6.6%–3 KCNQ1, 3 SCN5A, 1 HERG, 1 KCNH2. Conclusions: Systematic clinical screening in relatives of SADS victims has a diagnostic yield of 35% increasing to 40% with genetic testing. Electrical causes of SADS predominate in these families. These findings demonstrate that a systematic clinical screening programme in SADS families is both achievable and effective. The full impact of gene testing (including RyR mutations) upon diagnostic yield is awaited.

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Primary leptomeningeal lymphoma masquerading as infectious tubercular meningitis

BMJ Case Reports ◽

10.1136/bcr-2021-243574 ◽

2021 ◽

Vol 14 (9) ◽

pp. e243574

Author(s):

Salini Sumangala ◽

Thidar Htwe ◽

Yousuf Ansari ◽

Lidia Martinez- Alvarez

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Correct Diagnosis ◽

Central Nervous System Lymphoma ◽

Final Diagnosis ◽

Csf Analysis ◽

Antitubercular Treatment ◽

Lymphoma Treatment ◽

Work Up ◽

Timely Treatment

Primary central nervous system lymphoma (PCNSL) is infrequent and often poses diagnostic conundrums due to its protean manifestations. We present the case of a South Asian young man presenting with raised intracranial pressure and a lymphocytic cerebrospinal fluid (CSF) with pronounced hypoglycorrhachia. Progression of the neuro-ophthalmic signs while on early stages of antitubercular treatment led to additional investigations that produced a final diagnosis of primary leptomeningeal lymphoma. Treatment with chemoimmunotherapy (methotrexate, cytarabine, thiotepa and rituximab (MATRix)) achieved full radiological remission followed by successful autologous transplant. This case highlights the difficulties and diagnostic dilemmas when PCNSL presents as a chronic meningeal infiltrative process. While contextually this CSF is most often indicative of central nervous system tuberculosis and justifies empirical treatment initiation alone, it is essential to include differential diagnoses in the investigation work-up, which also carry poor prognosis without timely treatment. High suspicion, multidisciplinary collaboration and appropriate CSF analysis were the key for a correct diagnosis.

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Use of flexible bronchoscopy for rapid diagnosis of suspected tubercular cases in rural India

The Journal of Infection in Developing Countries ◽

10.3855/jidc.608 ◽

2009 ◽

Vol 3 (11) ◽

pp. 860-864 ◽

Cited By ~ 3

Author(s):

Sameer Singhal ◽

Abhay M. Gaidhane ◽

Nazli Khatib ◽

Tripti Hrivastava ◽

Sanjay Diwan ◽

...

Keyword(s):

Diagnostic Yield ◽

Correct Diagnosis ◽

Positive Culture ◽

Cross Sectional Study ◽

Flexible Bronchoscopy ◽

Special Importance ◽

Cross Sectional ◽

Tuberculosis Patients ◽

Negative Sputum ◽

Tuberculosis Therapy

Background: Reaching a correct diagnosis is a challenge for physicians treating any of the 30% to 50% of pulmonary tuberculosis patients who have negative sputum cultures or who present with no sputum. Flexible bronchoscopy acquires special importance for these cases for whom empirical anti-tuberculosis therapy is the only option left. In our study we aimed to assess the diagnostic yield of flexible bronchoscopy in patients, suspected to have tuberculosis, whose sputum smears were negative. Methodology: In our hospital-based cross-sectional study, 42 patients were enrolled by consecutive sampling. Flexible bronchoscopy and selective bronchial washings were done in all patients. Results: Bronchoscopy lavage smears were positive for M. tuberculosis in 10 (23.8%) patients. Fifteen (35.7%) patients had positive culture. Conclusion: Flexible bronchoscopy has an important role in the diagnosis of patients suspected to have tuberculosis, whose sputum smears are negative or who can not produce sputum.

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Should the ‘adenosine-challenge test’ be part of the routine work-up for syncope?The opinions expressed in this article are not necessarily those of the Editors of the Europace Journal or of the European Society of Cardiology.

EP Europace ◽

10.1093/europace/eum135 ◽

2007 ◽

Vol 9 (8) ◽

pp. 557-558 ◽

Cited By ~ 1

Author(s):

Sami Viskin ◽

Dan Justo ◽

Amir Halkin

Keyword(s):

European Society ◽

Challenge Test ◽

Routine Work ◽

European Society Of Cardiology ◽

Work Up

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Evaluation and Management of Neck and Back Pain

Seminars in Neurology ◽

10.1055/s-0038-1677044 ◽

2019 ◽

Vol 39 (01) ◽

pp. 041-052 ◽

Cited By ~ 2

Author(s):

Samuel Potter ◽

John Martel

Keyword(s):

Emergency Department ◽

Back Pain ◽

Treatment Options ◽

Initial Evaluation ◽

Morbidity And Mortality ◽

Significant Morbidity ◽

General Overview ◽

Work Up ◽

Evaluation Work

AbstractNeck and back pain are common reasons for seeking evaluation and treatment in the emergency department. Within both systems there exist several time-sensitive diagnoses that the emergency provider should be familiar with in order to prevent significant morbidity and mortality. In this article we provide a general overview of these complaints by discussing problems in a systems-based fashion as well as discussing the initial evaluation, work-up, and treatment options for these diagnoses.

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Diagnostic Yield of Pediatric Colonoscopies Based on Presenting Symptoms in a Secondary Hospital

Korean Journal of Pediatric Gastroenterology and Nutrition ◽

10.5223/kjpgn.2011.14.4.368 ◽

2011 ◽

Vol 14 (4) ◽

pp. 368

Author(s):

Yun Jung Cho ◽

Il Hyun Cho ◽

Hyo Joo Yoo ◽

Hwang Choi ◽

Bo-In Lee ◽

...

Keyword(s):

Diagnostic Yield ◽

Presenting Symptoms ◽

Secondary Hospital

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Severe asthma

10.1093/med/9780199657742.003.0002 ◽

2017 ◽

Author(s):

Anand Shah ◽

Andrew Menzies-Gow

Keyword(s):

Severe Asthma ◽

Correct Diagnosis ◽

Allergic Bronchopulmonary Aspergillosis ◽

Lost Work ◽

Inhaled Therapy ◽

Control Asthma ◽

Care Costs ◽

Significant Health ◽

Substantial Morbidity

Poorly controlled asthma is a common reason for referral to the respiratory clinic, and the majority of cases can be managed effectively by ensuring the correct diagnosis and ensuring good compliance with inhaled therapy. However, severe asthma affects up to 10% of patients with asthma and is associated with substantial morbidity and mortality, along with significant health-care costs from both inpatient treatment and lost work days. This chapter covers two cases of difficult-to-control asthma and highlights the role of detailed investigations when asthma control is not straightforward. It will cover the diagnostic criteria for allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization and discuss the role of omalizumab in managing severe asthma.

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Comparative Study between Plain Radiography and Ultrasound Abdomen in Non Traumatic Surgical Acute Abdominal Conditions

Nepalese Journal of Radiology ◽

10.3126/njr.v2i2.7681 ◽

2013 ◽

Vol 2 (2) ◽

pp. 20-27 ◽

Cited By ~ 1

Author(s):

Prakash Sharma ◽

Sidharth ◽

BP Singh ◽

D Singh ◽

A Gupta

Keyword(s):

Acute Abdomen ◽

Sensitivity And Specificity ◽

Diagnostic Yield ◽

Correct Diagnosis ◽

Plain Film ◽

Abdominal Ultrasound ◽

X Rays ◽

Laboratory Findings ◽

X Ray ◽

Ray Series

Introduction: Acute abdomen might indicate a progressive intra-abdominal condition that is threatening to life or capable of causing severe morbidity. A good history, thorough clinical examination, laboratory investigations and imaging studies is necessary in order to arrive at a correct diagnosis. The aim of our study was to compare the diagnostic yield of traditional three-view abdominal x-ray series (upright chest x-ray, supine and upright abdominal x-rays) with that of ultrasound in patients presenting with non traumatic acute abdominal surgical pain. Methods: This prospective study was conducted between February and July 2010 on 65 consecutive patients. Critically ill patients, pregnant ladies, patient with trauma abdomen, acute abdomen due to gynaecological pathologies were excluded from our study. Detail abdominal ultrasound was done. After ultrasound traditional three-views acute abdominal x-ray series (AAS) were taken. Final diagnosis was made on the basis of operative findings/therapeutic response/ histopathological/ laboratory findings. Finally, accuracy of clinical diagnosis, plain film and ultrasound in evaluation of acute abdomen was determined. Results: Ultrasound yielded an overall sensitivity and specificity of 78.7% and 84.6.6% respectively. The AAS interpretations yielded an overall sensitivity and specificity of 23.4% and 38.40% respectively. Conclusion: Plain x ray is less sensitive in the evaluation of nontraumatic acute abdomen so it should be used together with ultrasound abdomen in order to arrive at a correct diagnosis. Nepalese Journal of Radiology; Vol. 2; Issue 2; July-Dec. 2012; 20-27 DOI: http://dx.doi.org/10.3126/njr.v2i2.7681

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