105 Cost Analysis for the Risk-Stratification of Febrile Infants ≤ 60 Days Old

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e74-e75
Author(s):  
Zachary Dionisopoulos ◽  
Erin Strumpf ◽  
Gregory Anderson ◽  
Andre Guigui ◽  
Brett Burstein
Keyword(s):  
Risk Stratification ◽  
Real World ◽  
Bacterial Infections ◽  
False Negative ◽  
Prediction Rule ◽  
Cost Savings ◽  
Antibiotic Use ◽  
Research Network ◽  
True Negative ◽  
Test Characteristic

Abstract Primary Subject area Emergency Medicine - Paediatric Background Fever in the first months of life is among the most common clinical problems in pediatric healthcare. Nearly 2% of all infants will be evaluated for fever in an Emergency Department (ED) and approximately 10% harbor life-threatening serious bacterial infections (SBIs). The Rochester criteria are most widely used criteria for risk-stratification and predate modern biomarkers including procalcitonin (PCT). Recently, a high-performing prediction rule incorporating PCT was derived by the Pediatric Emergency Care Applied Research Network (PECARN). At present, PCT is not available in all clinical settings, limited largely by test cost. Objectives Compare the medical costs associated with PECARN and Rochester risk-stratification strategies using contemporary price, epidemiologic and test characteristic data. Design/Methods We assessed hospital-level costs associated with the door-to-discharge care of all well-appearing febrile infants aged ≤ 60 days evaluated at an urban tertiary pediatric hospital between April 2016 and March 2019. Direct and indirect ED and inpatient costs were obtained from provincial Ministry of Health data. Real-world costs were then incorporated into a probabilistic model for a cohort of equal size using either Rochester or PECARN risk-stratification, accounting for the added incremental cost of PCT ($24.86CAD). Models used an 8.4% pooled SBI risk, and Sn/Sp for Rochester and PECARN of 94%/49% and 98%/63%, respectively. Modeling was calculated under 4 scenarios; true positive with hospitalization, false negative with return visit and hospitalization, false positive with hospitalization, true negative with ED discharge. All costs were calculated in Canadian dollars. Results During the 3-year study period, 1168 index infant encounters met inclusion and were analyzed for hospital trajectory costs. Median costs per infant were $323 (IQR $286-$393) for infants discharged from the ED with no SBI, $2356 (IQR $1858-$3120) for infants hospitalized with no SBI, $3150 (IQR $2352-$4201) for hospitalized infants treated for a SBI, and $3763 (IQR $2146-$5180) for infants discharged from the ED ultimately requiring hospitalization with a missed SBI. For a cohort of 1168 infants, cost-per-infant using PECARN risk-stratification was $1332 (IQR $1062-$1739), compared to $1515 (IQR $1198-$1992) using Rochester. PECARN criteria would be expected to produce an overall savings of 12.1% for the modeled cohort ($1,556,432 vs $1,769,339). Under pessimistic and optimistic model assumptions, total savings were 4.9% and 18.3%, respectively. Costs borne by families were not considered, nor were the indirect benefits of reduced unnecessary invasive testing, hospitalizations and broad-spectrum antibiotic use. Conclusion Risk-stratification of febrile infants using PECARN prediction rules would produce important cost-savings due to superior test characteristics offsetting upfront PCT-associated costs. Such a strategy would also likely result in unmodeled non-monetary family-centered and healthcare system benefits. Real-world cost-effectiveness studies are needed.

scholarly journals Otkrivanje infekcija u abdomenu primenom radioobelezenog antibiotika

2003 ◽  
Vol 50 (2) ◽  
pp. 25-29 ◽  
Author(s):  
Vera Artiko ◽  
Branka Davidovic ◽  
Nadezda Nikolic ◽  
Milorad Petrovic ◽  
Nebojsa Petrovic ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Surgical Treatment ◽  
False Positive ◽  
Bacterial Infections ◽  
Conservative Therapy ◽  
False Negative ◽  
True Positive ◽  
True Negative ◽  
Exact Localization

The aim of the study is detection of the abdominal infective foci using 99mTc-ciprofloxacin, radiopharmaceutical supposed to distuinguish inflammation from infection. Twenty one patient was investigated. There were 11 true positive findings, 7 true negative, two were false negative, while 1 was false positive. Sensitivity of the method was 79% and specificity 91%. According to our results, scintigraphy with infecton is a useful method for detection and assessment of exact localization of deep seated bacterial infections, which might be useful for (differential) diagnosis, surgical treatment in due time as well as monitoring of the treatment of conservative therapy.

Analysis to determine cost-effectiveness of procalcitonin-guided antibiotic use in adult patients with suspected bacterial infection and sepsis

2019 ◽  
Vol 76 (16) ◽  
pp. 1219-1225 ◽  
Author(s):  
Curtis D Collins ◽  
Kara Brockhaus ◽  
Taeyong Sim ◽  
Anupam Suneja ◽  
Anurag N Malani
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cost Effectiveness ◽  
Antibiotic Therapy ◽  
Real World ◽  
Hospital Cost ◽  
Cost Savings ◽  
Antibiotic Use ◽  
Base Case ◽  
Decision Analytic Model

Abstract Purpose Results of a study incorporating real-world results into a predictive model to assess the cost-effectiveness of procalcitonin (PCT)-guided antibiotic use in intensive care unit patients with sepsis are reported. Methods A single-center, retrospective cross-sectional study was conducted to determine whether reductions in antibiotic therapy duration and other care improvements resulting from PCT testing and use of an associated treatment pathway offset the costs of PCT testing. Selected base-case cost outcomes in adults with sepsis admitted to a medical intensive care unit (MICU) were assessed in preintervention and postintervention cohorts using a decision analytic model. Cost-minimization and cost–utility analyses were performed from the hospital perspective with a 1-year time horizon. Secondary and univariate sensitivity analyses tested a variety of clinically relevant scenarios and the robustness of the model. Results Base-case modeling predicted that use of a PCT-guided treatment algorithm would results in hospital cost savings of $45 per patient and result in a gain of 0.0001 quality-adjusted life-year. After exclusion of patients in the postintervention cohort for PCT test ordering outside of institutional guidelines, the mean inpatient antibiotic therapy duration was significantly reduced in the postintervention group relative to the preintervention group (6.2 days versus 4.9 days, p = 0.04) after adjustment for patient sex and age, Charlson Comorbidity Index score, study period, vasopressor use, and ventilator use. Total annual hospital cost savings of $4,840 were predicted. Conclusion Real-world implementation of PCT-guided antibiotic use may have improved patients’ quality of life while decreasing hospital costs in MICU patients with undifferentiated sepsis.

Performance of Five Ultrasound Risk Stratification Systems in Selecting Thyroid Nodules for FNA

2019 ◽  
Vol 105 (5) ◽  
pp. 1659-1669 ◽  
Author(s):  
Marco Castellana ◽  
Carlo Castellana ◽  
Giorgio Treglia ◽  
Francesco Giorgino ◽  
Luca Giovanella ◽  
...  
Keyword(s):  
Systematic Review ◽  
Risk Stratification ◽  
Thyroid Nodules ◽  
Data Extraction ◽  
Meta Analysis ◽  
False Negative ◽  
Final Diagnosis ◽  
Diagnostic Odds Ratio ◽  
Needle Aspiration ◽  
True Negative

Abstract Context Ultrasound (US) risk stratification systems (RSSs) have been developed to reduce the number of unnecessary fine-needle aspiration procedures (FNA) in patients with thyroid nodules. Objective We conducted a systematic review and meta-analysis evaluating the ability of the 5 most common US RSSs for the appropriate selection of thyroid nodules for FNA. Data sources This systematic review and meta-analysis was registered on PROSPERO (CRD42019131771). PubMed, CENTRAL, Scopus, and Web of Science were searched until March 2019. Study selection Original articles reporting data on the performance of AACE/ACE/AME, ACR TI-RADS, ATA, EU-TIRADS, and K-TIRADS were included. Data extraction The number of nodules classified as true negative, true positive, false negative, and false positive was extracted. Summary operating points were estimated using a random-effects model. Interobserver agreement was also assessed. Data synthesis Twelve studies evaluating 18 750 thyroid nodules were included. Participants were adult outpatients with thyroid nodules submitted to either FNA or core-needle biopsy or surgery and with available US images. The final diagnosis for malignant nodules was generally based on histology, while cytology was used for benign nodules. Diagnostic odds ratio (DOR) ranged from 2.2 to 4.9. A head-to-head comparison showed a higher relative DOR for ACR-TIRADS versus ATA (P = .002) or K-TIRADS (P = .002), due to a higher relative likelihood ratio for positive results. Conclusions The present meta-analysis found a higher performance of ACR TI-RADS in selecting thyroid nodules for FNA. However, the comparison across the most common US RSSs was limited by the data available. Further studies are needed to confirm this finding.

The role of serum periostin in the diagnosis of asthma: A meta-analysis

2020 ◽  
Vol 41 (4) ◽  
pp. 240-247
Author(s):  
Lei Yang ◽  
Qingtao Zhao ◽  
Shuyu Wang
Keyword(s):  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
False Negative ◽  
Summary Receiver Operating Characteristic ◽  
True Negative ◽  
Negative Results ◽  
Noninvasive Biomarker ◽  
Sensitivity Specificity ◽  
Serum Periostin

Background: Serum periostin has been proposed as a noninvasive biomarker for asthma diagnosis and management. However, its accuracy for the diagnosis of asthma in different populations is not completely clear. Methods: This meta-analysis aimed to evaluate the diagnostic accuracy of periostin level in the clinical determination of asthma. Several medical literature data bases were searched for relevant studies through December 1, 2019. The numbers of patients with true-positive, false-positive, false-negative, and true-negative results for the periostin level were extracted from each individual study. We assessed the risk of bias by using Quality Assessment of Diagnostic Accuracy Studies 2. We used the meta-analysis to produce summary estimates of accuracy. Results: In total, nine studies with 1757 subjects met the inclusion criteria. The pooled estimates of sensitivity, specificity, and diagnostic odds ratios for the detection of asthma were 0.58 (95% confidence interval [CI], 0.38‐0.76), 0.86 (95% CI, 0.74‐0.93), and 8.28 (95% CI, 3.67‐18.68), respectively. The area under the summary receiver operating characteristic curve was 0.82 (95% CI, 0.79‐0.85). And significant publication bias was found in this meta‐analysis (p = 0.39). Conclusion: Serum periostin may be used for the diagnosis of asthma, with moderate diagnostic accuracy.

Procalcitonin Testingreduce Unnecessary Antibiotic Use in Bacterial Infection

2019 ◽  
Vol 2 (1) ◽  
pp. 1-3
Author(s):  
Attabak Toofani Milani ◽  
Mahshid Mohammadian ◽  
Sadegh Rostaminasab ◽  
Roghayeh Paribananaem ◽  
Zohre Ahmadi ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Infection ◽  
Diagnostic Test ◽  
Bacterial Infections ◽  
Intervention Studies ◽  
Antibiotic Use ◽  
Clinical Suspicion ◽  
Diagnostic Biomarker ◽  
Clinical Routine ◽  
Initial Rise

Conventional diagnostic test have limitations to deferential diagnosis in clinical suspicion ofbacterial infection cases, that in some cases lead to inappropriate antibiotic therapy and increases antibiotic resistance. A new diagnostic insight is procalcitonin (PCT) test to improve diagnosis of bacterial infections and to guide antibiotic therapy. Serum PCT levels are of useful test as a biomarker in patients with bacterial infections for several reasons. Initial rise of PCT levels due to bacterial infection, subsequent sequential PCT levels can be used to assess the effectiveness and duration of antibiotic therapy. Based on clinical researches results, in bacterial infections, promising good results obtained when use of PCT used as differential diagnostic test. But further intervention studies are needed before use of PCT in clinical routine tests. The goal of this review is to study the PCT reliability as infections diagnostic biomarker.

scholarly journals Infection Preventionist Run Clostridioides difficile Testing Diagnostic Stewardship Protocol- Experience From a Rural Community Hospital

2020 ◽  
Vol 41 (S1) ◽  
pp. s484-s485
Author(s):  
Raghavendra Tirupathi ◽  
Ruth Freshman ◽  
Norma J Montoy ◽  
Melissa Gross
Keyword(s):  
Cost Savings ◽  
Antibiotic Use ◽  
First Year ◽  
Multiple Parameters ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
Commercial Company ◽  
Surgical History ◽  
Test Ordering ◽  
Infection Preventionists

Background: Distinguishing active Clostridioides difficile infection (CDI) from asymptomatic colonization remains a challenging task in the era of PCR testing. Inappropriate testing leads to overtesting and overdiagnosis, inadvertent treatment, and isolation in addition to laboratory identified (LabID) events, leading to increased incidence to hospital-onset CDI (HO-CDI). The institution has a nurse-driven C. difficile test ordering protocol, and we noted a significant increase in the HO-CDI incidence in 2017 due to inappropriate testing, with rates as high as 0.94 per 1,000 patient days. Methods: In September 2017, a multidisciplinary team reviewed and initiated algorithm-based testing with mandatory audit and review by infection preventionists (IPs) under the guidance of an ID physician of all ordered tests. They reviewed the adequacy and legitimacy of order for multiple parameters, including minimum 3 loose stools in 24 hours, use of laxatives in last 24 hours, consistency of the sample, presence of at least 1 clinical parameters (ie, fever, abdominal pain, leukocytosis, sepsis, or septic shock), recent or concomitant antibiotic use, recent PCR testing in the last 14 days, and chart review for medical and/or surgical history. The IPs served as the gatekeepers to testing and rejected the samples that were deemed inappropriate. Ambiguous cases were discussed with the ID specialist. On the microscope lab side, all specimens sent were batched to be run twice a day at 8:30 a.m. and 2:30 p.m., and testing was performed only on the samples cleared by infection preventionists. Results: The number of PCR tests completed in the comparison quarter of 2016 was 220, which decreased to 157 tests in 2017 with a reduction of 28%. After a full year of implementation of the diagnostic stewardship protocol, the number of completed PCR tests decreased to 626 from 940 PCR tests in 2016, with an overall 34% decrease in testing. In the year following the implementation of diagnostic stewardship, HO-CDI decreased from 60 events in 2017 to 43 events in 2018, with a reduction of 28%. Subsequently, HO-CDI further decreased in 2019 from 43 to 28, with a reduction of 35%. Since the implementation of the project in 2017, HO-CDIs have decreased by 54% overall. The reduction in 314 C. difficile PCR tests in the first year led to a savings of $8,300 in laboratory testing supplies. The reduction of HO CDI by 17 led to cost avoidance of $293,420. Conclusions: Our experience shows that the IP-run diagnostic stewardship program was highly successful in streamlining testing, with cost savings on several fronts.Funding: NoneDisclosures: NoneDisclosures:Commercial Company : If I am presenting research funded by a commercial company, the information presented will be based on generally accepted scientific principals and methods, and will not promote the commercial interest of the funding company.DisagreeRaghavendra Tirupathi

scholarly journals A multicenter, hospital-based and non-inferiority study for diagnostic efficacy of automated whole breast ultrasound for breast cancer in China

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yujing Xin ◽  
Xinyuan Zhang ◽  
Yi Yang ◽  
Yi Chen ◽  
Yanan Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
False Negative ◽  
Final Analysis ◽  
Age Group ◽  
Surgical Biopsy ◽  
True Negative ◽  
Diagnostic Efficacy ◽  
Negative Results ◽  
Informed Consent Form ◽  
Magnetic Resonance Imaging Mri

AbstractThis study is the first multi-center non-inferiority study that aims to critically evaluate the effectiveness of HHUS/ABUS in China breast cancer detection. This was a multicenter hospital-based study. Five hospitals participated in this study. Women (30–69 years old) with defined criteria were invited for breast examination by HHUS, ABUS or/and mammography. For BI-RADS category 3, an additional magnetic resonance imaging (MRI) test was provided to distinguish the true negative results from false negative results. For women classified as BI-RADS category 4 or 5, either core aspiration biopsy or surgical biopsy was done to confirm the diagnosis. Between February 2016 and March 2017, 2844 women signed the informed consent form, and 1947 of them involved in final analysis (680 were 30 to 39 years old, 1267 were 40 to 69 years old).For all participants, ABUS sensitivity (91.81%) compared with HHUS sensitivity (94.70%) with non-inferior Z tests, P = 0.015. In the 40–69 age group, non-inferior Z tests showed that ABUS sensitivity (93.01%) was non-inferior to MG sensitivity (86.02%) with P < 0.001 and HHUS sensitivity (95.44%) was non-inferior to MG sensitivity (86.02%) with P < 0.001. Sensitivity of ABUS and HHUS are all superior to that of MG with P < 0.001 by superior test.For all participants, ABUS specificity (92.89%) was non-inferior to HHUS specificity (89.36%) with P < 0.001. Superiority test show that specificity of ABUS was superior to that of HHUS with P < 0.001. In the 40–69 age group, ABUS specificity (92.86%) was non-inferior to MG specificity (91.68%) with P < 0.001 and HHUS specificity (89.55%) was non-inferior to MG specificity (91.68%) with P < 0.001. ABUS is not superior to MG with P = 0.114 by superior test. The sensitivity of ABUS/HHUS is superior to that of MG. The specificity of ABUS/HHUS is non-inferior to that of MG. In China, for an experienced US radiologist, both HHUS and ABUS have better diagnostic efficacy than MG in symptomatic individuals.

scholarly journals How reliable is procalcitonin as an inflammatory marker?1)

2012 ◽  
Vol 35 (6) ◽  
pp. ---
Author(s):  
Katharina Biller ◽  
Peter Fae ◽  
Reinhard Germann ◽  
Autar K. Walli ◽  
Peter Fraunberger
Keyword(s):  
Intensive Care ◽  
Diagnostic Tool ◽  
Plasma Levels ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Inflammatory Marker ◽  
Antibiotic Use ◽  
Intensive Care Patients ◽  
Tract Infections

Abstract The role of procalcitonin (PCT) plasma levels as a diagnostic tool for intensive care patients has been intensively investigated during the past years. In particular for recognition of bacterial infections, PCT levels have been shown to be superior to other clinical and biochemical markers. Furthermore, some very recent studies show that in patients with lower respiratory tract infections PCT guided antibiotic therapy reduces antibiotic use and thereby may also reduce duration of stay of patients in hospital and thus cut hospitalisation costs. However, various studies indicate that the value of PCT as a prognostic marker is limited because of false positive or negative values. Despite these limitations PCT plasma levels are currently measured in intensive care units. The present study summarises the possible clinical uses of this laboratory marker as a diagnostic tool for the assessment of critically ill patients.

scholarly journals Antibiotic Use in Periodontal Therapy among French Dentists and Factors Which Influence Prescribing Practices

Antibiotics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 303
Author(s):  
Kevimy Agossa ◽  
Kadiatou Sy ◽  
Théo Mainville ◽  
Marjolaine Gosset ◽  
Sylvie Jeanne ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Aggressive Periodontitis ◽  
Periodontal Therapy ◽  
Research Network ◽  
Prescribing Practices ◽  
French Society ◽  
Private Practitioners ◽  
First Line Therapy ◽  
Practice Based Research ◽  
Systemic Antibiotics

The aim of the present survey is to investigate the use of antibiotics during periodontal therapy among French dentists with a focus on exploring potential differences between various groups of practitioners. A self-administered questionnaire was distributed to different groups of practitioners including members of (i) the French Society of Periodontology and Implantology; (ii) the College of University Teachers in Periodontology and, (iii) private practitioners participating in the French general dental practice-based research network. 272 questionnaires were included in the analysis. Prescription patterns were globally in line with the current recommendations. Systemic antibiotics are most frequently used as a first-line therapy in necrotizing periodontitis (92%) and aggressive periodontitis (53.3% to 66.1%). However, malpractice still exists, including in the management of periodontal abscesses. Antibiotics are prescribed (i) less frequently for periodontal abscesses and (ii) more frequently for generalized aggressive periodontitis by members of the periodontal society and University college (p < 0.05). Amoxicillin (59.9%) and the amoxicillin + metronidazole (59.6%) combination were the most frequently prescribed molecules. Providing a high number of periodontal treatments per week, being more recently graduated, having a post-graduate certificate in periodontology and holding or having held an academic position/hospital practice were all factors associated with a better knowledge of and/or more adequate antibiotic use.

Sign in / Sign up

Export Citation Format

Share Document