Pleural Ultrasonography versus Chest Radiography for the Diagnosis of Pneumothorax

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Amir Ibrahim Salah ◽  
Heba Bahaa el-Dien El- Serwi ◽  
Amin Mohammad Al Ansary ◽  
Ahmed Badawy Ibrahim Houssien
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
High Reliability ◽  
Venous Catheter ◽  
Central Line ◽  
X Ray ◽  
Central Line Insertion ◽  
Line Insertion ◽  
Chest X Ray

Abstract Background Pneumothorax (PTX) is an emergency that requires urgent management to avoid catastrophic consequences. PTX is also an important cause of respiratory failure in the emergency department, and may occur frequently as a complication of central venous catheter insertion. Aim The aim of this study is to compare the diagnostic accuracy of bedside lung US with those for anteroposterior (AP) chest X ray (CXR) for the detection of PTX in critically ill patients. Methods This study was conducted on fifty adult patients from both sexes, mechanically ventilated at least 48 hours and planned for central line insertion. We excluded overt pneumothorax, patients requiring immediate invasive intervention, pregnancy and lactation. Lung ultrasound was done to all patients after 30 minutes from central line insertion followed by CXR to confirm the diagnosis of pneumothorax. Pneumothorax was confirmed using CT chest. Results Results showed that ultrasound is superior to chest X Ray in detection of PTX.Ultrasound showed sensitivity of 94.87%, specificity of 81.82%, positive predictive value of 94.87%, negative predictive value of 21.82% and accuracy of 92.0% in detection of PTX, while Chest X Ray showed sensitivity of 76.92%, specificity of 63.64%, positive predictive value of 88.24%, negative predictive value of 43.75% and accuracy of 74.0% in detection of PTX. Conclusions In conclusion, US represent a good approach for the evaluation of PTX, with advantages of timeliness, high accuracy and high reliability.

scholarly journals Comparison of Lung Ultrasound to X-ray for Diagnosis of Pulmonary Complications after Cardiac Surgery in Children

2020 ◽  
Vol 18 (1) ◽  
pp. 47-51
Author(s):  
Smriti Mahaju Bajracharya ◽  
Pragati Shrestha ◽  
Apurb Sharma
Keyword(s):  
Cardiac Surgery ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Lung Ultrasound ◽  
Pulmonary Complications ◽  
Lung Ultrasonography ◽  
X Ray ◽  
Chest X Ray

Background: The purpose of this study was to compare diagnostic performance of lung ultrasound in comparison to chest X-ray to detect pulmonary complication after cardiac surgery in children.Methods: A prospective observational study was conducted in tertiary center of Nepal. 141 consecutive paediatric patients aged less than 14 years scheduled for cardiac surgery were enrolled during the 6 months period. Ultrasound was done on the first post-operative day of cardiac surgery and compared to chest X-ray done on the same day to detect pleural effusion, consolidation, atelectasis and pneumothorax.Results: Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were calculated using standard formulas. lung ultrasonography had overall sensitivity of 60 %, specificity of 72.4%, positive predictive value of 31.9% and negative predictive value of 89.3% and diagnostic accuracy of 70.2% for diagnosing consolidation. Similarly, lung ultrasonography had overall sensitivity of 90%, specificity of 82.6%, positive predictive value of 46.1% and negative predictive value of 98% and diagnostic accuracy of 83.6 % for diagnosing pleural effusion. For atelectasis, ultrasonography had sensitivity of 50%, specificity of 76.9%, positive predictive value of 30.7% and negative predictive value of 88.2% and diagnostic accuracy of 72.3%. No pneumothoraxes were detected during our study period. Conclusions: Lung ultrasound is an alternative non-invasive technique which is able to diagnose pulmonary complications after cardiac surgery with acceptable diagnostic accuracy with no proven complications but with decreasing exposure to ionizing radiation and possibly cost.Keywords: Cardiac surgery; children; lung ultrasound; pulmonary complications

Ultrasound Detection of Pneumothorax Compared with Chest X-Ray and Computed Tomography Scan

2011 ◽  
Vol 77 (4) ◽  
pp. 480-483 ◽  
Author(s):  
Khanjan Nagarsheth ◽  
Stanley Kurek
Keyword(s):  
Ct Scan ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Chest Ct ◽  
Trauma Patients ◽  
X Rays ◽  
Thoracic Ultrasound ◽  
X Ray ◽  
Chest X Ray ◽  
Chest Ct Scan

Pneumothorax after trauma can be a life threatening injury and its care requires expeditious and accurate diagnosis and possible intervention. We performed a prospective, single blinded study with convenience sampling at a Level I trauma center comparing thoracic ultrasound with chest X-ray and CT scan in the detection of traumatic pneumothorax. Trauma patients that received a thoracic ultrasound, chest X-ray, and chest CT scan were included in the study. The chest X-rays were read by a radiologist who was blinded to the thoracic ultrasound results. Then both were compared with CT scan results. One hundred and twenty-five patients had a thoracic ultrasound performed in the 24-month period. Forty-six patients were excluded from the study due to lack of either a chest X-ray or chest CT scan. Of the remaining 79 patients there were 22 positive pneumothorax found by CT and of those 18 (82%) were found on ultrasound and 7 (32%) were found on chest X-ray. The sensitivity of thoracic ultrasound was found to be 81.8 per cent and the specificity was found to be 100 per cent. The sensitivity of chest X-ray was found to be 31.8 per cent and again the specificity was found to be 100 per cent. The negative predictive value of thoracic ultrasound for pneumothorax was 0.934 and the negative predictive value for chest X-ray for pneumothorax was found to be 0.792. We advocate the use of chest ultrasound for detection of pneumothorax in trauma patients.

Validation of Statewide Surveillance System Data on Central Line–Associated Bloodstream Infection in Intensive Care Units in Australia

2009 ◽  
Vol 30 (11) ◽  
pp. 1045-1049 ◽  
Author(s):  
Emma S. McBryde ◽  
Judy Brett ◽  
Philip L. Russo ◽  
Leon J. Worth ◽  
Ann L. Bull ◽  
...  
Keyword(s):  
Intensive Care ◽  
Positive Predictive Value ◽  
Infection Control ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Surveillance System ◽  
Central Line ◽  
Public Hospitals ◽  
Definition Of

Objective.To measure the interobserver agreement, sensitivity, specificity, positive predictive value, and negative predictive value of data submitted to a statewide surveillance system for identifying central line-associated bloodstream infection (BSI).Design.Retrospective review of hospital medical records comparing reported data with gold standard according to definitions of central line–associated BSI.Setting.Six Victorian public hospitals with more than 100 beds.Methods.Reporting of surveillance outcomes was undertaken by infection control practitioners at the hospital sites. Retrospective evaluation of the surveillance process was carried out by independent infection control practitioners from the Victorian Hospital Acquired Infection Surveillance System (VICNISS). A sample of records of patients reported to have a central line-associated BSI were assessed to determine whether they met the definition of central line–associated BSI. A sample of records of patients with bacteremia in the intensive care unit during the assessment period who were not reported as having central line–associated BSI were also assessed to see whether they met the definition of central line-associated BSI.Results.Records of 108 patients were reviewed; the agreement between surveillance reports and the VICNISS assessment was 67.6% (κ = 0.31). Of the 46 reported central line–associated BSIs, 27 were confirmed to be central line–associated BSIs, for a positive predictive value of 59% (95% confidence interval [CI], 43%–73%). Of the 62 cases of bacteremia reviewed that were not reported as central line–associated BSIs, 45 were not associated with a central line, for a negative predictive value of 73% (95% CI, 60%–83%). Estimated sensitivity was 35%, and specificity was 87%. The positive likelihood ratio was 3.0, and the negative likelihood ratio was 0.72.Discussion.The agreement between the reporting of central line–associated BSI and the gold standard application of definitions was unacceptably low. False-negative results were problematic; more than half of central line–associated BSIs may be missed in Victorian public hospitals.

Reduction of central line-associated bloodstream infections in a large acute care hospital in Midwest United States following implementation of a comprehensive central line insertion and maintenance bundle

2021 ◽  
pp. 175717742110124
Author(s):  
Abraham E Wei ◽  
Ronald J Markert ◽  
Christopher Connelly ◽  
Hari Polenakovik
Keyword(s):  
Medical Condition ◽  
Acute Care Hospital ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Annual Number ◽  
Care Hospital ◽  
Central Line Insertion ◽  
Line Insertion ◽  
The Impact

Background: Central line-associated bloodstream infection (CLABSI) is a preventable medical condition that results in increased patient morbidity and mortality. We describe the impact of various quality improvement interventions on the incidence of CLABSI in an 848-bed community teaching hospital from 1 January 2013 to 31 December 2017. Aim: To reduce CLABSI rates after implementation of a comprehensive central line insertion and maintenance bundle. Methods: A comprehensive bundle of interventions was implemented incorporating the standard US Centers for Disease Control and Prevention bundle with additional measures such as root-cause analysis of all CLABSI cases, use of passive disinfection caps on vascular access ports, standardisation of weekly central venous catheter (CVC) site dressing changes, and use of antithrombotic and antimicrobial-coated CVCs with fewer lumens. A retrospective study evaluated CLABSI rates and time of CLABSI onset after CVC placement in both intensive care unit (ICU) and non-ICU settings. Results: The annual number of CLABSI cases declined 68% (34 to 11 patients) from 2013 to 2017. There was a 30% decline in CVC days from years 2014 to 2017. Over the same period, CLABSI cases per 1000 CVC days decreased from 0.624 to 0.362: a 42% decline. Conclusion: Following the implementation of a comprehensive bundle of interventions for CVC insertion and maintenance, we found a reduction in rates of CLABSI.

scholarly journals Washing of Gloved Hands in Antiseptic Solution Prior to Central Venous Line Insertion Reduces Contamination

2002 ◽  
Vol 30 (3) ◽  
pp. 338-340 ◽  
Author(s):  
H. Kocent ◽  
C. Corke ◽  
A. Alajeel ◽  
S. Graves
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Line ◽  
Central Venous Line ◽  
Contamination Rate ◽  
Central Venous ◽  
Antiseptic Solution ◽  
Central Line Insertion ◽  
Line Insertion ◽  
Experienced Resident

Glove contamination at the time a central venous catheter is handled is highly undesirable and likely to increase the risk of subsequent line infection. This study was designed to determine how frequently gloves become contaminated during central venous line insertion and to demonstrate the value of glove decontamination immediately prior to handling of the central venous catheter. During twenty routine internal jugular catheter insertions the sterility of the operator's gloved fingertips (just prior to handling the intravenous catheter) was assessed by touching the fingertips onto blood agar plates. The gloved hands were then rinsed in chlorhexidine/alcohol and after drying were placed onto a further plate. Contamination was detected in 55% of the prewash plates but in none of the postwash plates. Procedures performed by less experienced resident staff had a higher contamination rate despite there being no evident breach of sterile technique. It is likely that glove contamination results from the persistance of bacteria within the deeper layers of the skin, despite surface disinfection. These bacteria may be released by manipulation of the skin when identifying landmarks. This hypothesis was supported by a subsequent observation that gloves were more highly contaminated after firm touching of the skin rather than light touching. Glove contamination during central line insertion is frequent. Catheter contamination rates could be reduced (without risk or additional cost) by rinsing gloved hands in a solution of chlorhexidine (0.5%) in alcohol (70%) prior to handling the catheter.

scholarly journals Using Artificial Intelligence for COVID-19 Chest X-ray Diagnosis

2020 ◽  
Author(s):  
Andrew A Borkowski ◽  
Narayan A Viswanadham ◽  
L Brannon Thomas ◽  
Rodney D Guzman ◽  
Lauren A Deland ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Detection System ◽  
Diagnostic Methods ◽  
Normal Lung ◽  
High Morbidity ◽  
X Ray ◽  
Chest X Ray ◽  
Time Required

Coronavirus disease-19 (COVID-19), caused by a novel member of the coronavirus family, is a respiratory disease that rapidly reached pandemic proportions with high morbidity and mortality. It has had a dramatic impact on society and world economies in only a few months. COVID-19 presents numerous challenges to all aspects of healthcare, including reliable methods for diagnosis, treatment, and prevention. Initial efforts to contain the spread of the virus were hampered by the time required to develop reliable diagnostic methods. Artificial intelligence (AI) is a rapidly growing field of computer science with many applications to healthcare. Machine learning is a subset of AI that employs deep learning with neural network algorithms. It can recognize patterns and achieve complex computational tasks often far quicker and with increased precision than humans. In this manuscript, we explore the potential for a simple and widely available test as a chest x-ray (CXR) to be utilized with AI to diagnose COVID-19 reliably. Microsoft CustomVision is an automated image classification and object detection system that is a part of Microsoft Azure Cognitive Services. We utilized publicly available CXR images for patients with COVID-19 pneumonia, pneumonia from other etiologies, and normal CXRs as a dataset to train Microsoft CustomVision. Our trained model overall demonstrated 92.9% sensitivity (recall) and positive predictive value (precision), with results for each label showing sensitivity and positive predictive value at 94.8% and 98.9% for COVID-19 pneumonia, 89% and 91.8% for non-COVID-19 pneumonia, 95% and 88.8% for normal lung. We then validated the program using CXRs of patients from our institution with confirmed COVID-19 diagnoses along with non-COVID-19 pneumonia and normal CXRs. Our model performed with 100% sensitivity, 95% specificity, 97% accuracy, 91% positive predictive value, and 100% negative predictive value. Finally, we developed and described a publicly available website to demonstrate how this technology can be made readily available in the future.

scholarly journals Diagnostic Accuracy of Ultrasound and Plain X-Ray KUB (Kidney, Ureter, Bladder) Compared to Non-Contrast CT (Computed Tomography) in Patients of Ureteric Calculi

2020 ◽  
Vol 7 (47) ◽  
pp. 2762-2766
Author(s):  
N. Imdad Ali ◽  
Noor Elahi Pasha ◽  
Ravishankar T.H.S
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
X Ray ◽  
Ureteric Calculus ◽  
Ureteric Calculi ◽  
Ureteric Colic ◽  
Contrast Ct

BACKGROUND Imaging plays a major role in the diagnosis and management of patients with urolithiasis. Non-Contrast Computed Tomography (NCCT) is generally accepted as the gold standard, but there are concerns over higher radiation exposure from NCCT to the patient population. Our prospective study compared the diagnostic accuracy of plain X-ray KUB (Kidney, Ureter, Bladder) and USG (Ultrasonography) with NCCT in the evaluation of patients with ureteric colic. METHODS This study conducted from December 2018 to January 2020 in the Department of Urology, Vijayanagar Institute of Medical Sciences, and attached Hospital. 230 patients with ureteric colic were evaluated for ureteric calculi with x-ray KUB, USG (Ultrasonography) abdomen and pelvis and NCCT (Non-Contrast Computed Tomography) KUB region. RESULTS Out of 230 patients, 168 (73 %) were males and 62 (26.9 %) were females. Ages of the study population ranged from 18 to 55 yrs. 198 of the 230 patients were confirmed to have ureteric calculus, with lower ureteric calculus 97 (48.9 %), upper ureteric 65 (32.8 %), middle ureteric 29 (14.6 %), and multiple 7 (3.5 %). X-ray and USG (Ultrasonography) group yielded a sensitivity of 86.3 %, a specificity of 87.5 %, positive predictive value 97 %, and negative predictive value 51 %. While On NCCT (Non-Contrast Computed Tomography), a total of 192 patients (96 %) demonstrated ureterolithiasis of the 198 patients confirmed to have ureteric calculi (Table 2). X-ray and USG group yielded a sensitivity of 96.9 %, specificity of 93.6 %, positive predictive value 98.9 %, and negative predictive value 83 %. CONCLUSIONS Combination of x-ray KUB and USG, and NCCT were found to be excellent imaging modalities for the detection of ureteric calculi. X-ray KUB and USG can be used as the first investigation of choice for patients with ureteric colic and for follow up of patients after treatment. KEYWORDS Ureteric Colic, Ureterolithiasis, Ultrasonography

scholarly journals Role and Responsibility of Nurses in Central Line - Insertion and Maintenance

2021 ◽  
Vol 8 (9) ◽  
pp. 252-260
Author(s):  
R. Surendra Naik ◽  
Avadhesh Kumar Yadav ◽  
Rajendra Kumar Sahu
Keyword(s):  
Central Venous Catheter ◽  
Subclavian Vein ◽  
Venous Catheter ◽  
Venous Access ◽  
Central Line ◽  
Axillary Vein ◽  
Central Venous ◽  
Central Line Insertion ◽  
Hematoma Formation ◽  
Line Insertion

Introduction -A central venous catheter (CVC) is thin, a flexible tube (catheter) that is placed into a large vein above the Heart. It may be inserted through A vein in the Neck, (internal jugular) chest (subclavian vein. Axillary vein) groin (femoral vein), or through veins in the arms known as a PICC, or peripherally inserted central catheters. Site- Internal jugular vein, subclavian vein, axillary vein, femoral veins, the best approach or access point for Central line insertion. Indications - The indications for central venous access are broad and are often situational. Inability to obtain venous access in emergent situations, chemotherapy administration, medications administration (Vasopressors. inotropic administration Total Parental nutrition administration, Hemodynamic monitoring are common indications for CVC insertion. Contraindication- Local cellulitis, Low platelet count, Local infections, Thrombocytopenia, Congenital anomalies, Trauma are common contraindications of CVC insertion. Complications - Numerous potential complications can occur during the procedural placement of a central venous catheter, but also as a result of the indwelling equipment. Arrhythmias, Arterial puncture, Pulmonary puncture with or without resultant pneumothorax, Bleeding – hematoma formation, which can obstruct the airway, Tracheal injury, Air emboli during venous puncture or removal of the catheter, Pulmonary embolism, Local cellulitis, Catheter infection, Cardiac tamponade, Intravascular loss of guidewire, Hamo thorax, Phrenic nerve injury, Brachial plexus injury, Cerebral infarct from carotid artery cannulation, Bladder perforation, Bowel perforation, Sterile Thrombophlebitis. Post-procedural complications: Catheter-related bloodstream infections – bacterial or fungal, Central vein stenosis, Thrombosis, Delayed bleeding with multiple attempts in a coagulopathic patient Clinical Significance - Ensure that sterile products are not contaminated and that there is no evidence of damage to the packaging. Follow sterile procedures at all times. Central line infections can be a serious and life-threatening illness. Always ensure that the catheter is appropriately placed through one or several methods: radiographic evidence, measurement of CVP, or by analyzing a venous blood gas. Never use excessive force during any part of this procedure. It will lead to damage to local structures. Nursing Responsibility - After a CVC placement, nurses are responsible for maintaining, monitoring, and utilizing central venous catheters. The assigned nurse must check complications such as infections, hematoma, thrombosis of the catheter, and signs of pneumothorax and bleeding. Nurses are also responsible for ensuring that the site is maintained in a clean and sterile fashion. Daily inspection of the access site and device patency should be performed during nursing rounds. In particular, nursing officers must disinfect injection ports, catheter hubs, and needleless connectors with institutionally approved antiseptics. Intravenous administration sets should be changed regularly per hospital policy. The site should be checked for bleeding, hematoma formation, and signs of cellulitis, which include erythema, purulent drainage, and/or warmth. Dressings should be changed if visibly soiled. This must be performed with proper sterile technique. Keywords: CVC, Central Line, Central venous catheter.

scholarly journals Added value of diffusion-weighted MRI in assessment of pleural lesions

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Youssriah Yahia Sabri ◽  
Ikram Hamed Mahmoud ◽  
Lamis Tarek El-Gendy ◽  
Mohamed Raafat Abd El-Mageed ◽  
Sally Fouad Tadros
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diagnostic Value ◽  
Added Value ◽  
Adc Value ◽  
Pleural Diseases ◽  
Conventional Mri ◽  
Malignant Lesions

Abstract Background There are many causes of pleural disease including variable benign and malignant etiologies. DWI is a non-enhanced functional MRI technique that allows qualitative and quantitative characterization of tissues based on their water molecules diffusivity. The aim of this study was to evaluate the diagnostic value of DWI-MRI in detection and characterization of pleural diseases and its capability in differentiating benign from malignant pleural lesions. Results Conventional MRI was able to discriminate benign from malignant lesions by using morphological features (contour and thickness) with sensitivity 89.29%, specificity 76%, positive predictive value 89%, negative predictive value 76.92%, and accuracy 85.37%. ADC value as a quantitative parameter of DWI found that ADC values of malignant pleural diseases were significantly lower than that of benign lesions (P < 0.001). Hence, we discovered that using ADC mean value of 1.68 × 10-3 mm2/s as a cutoff value can differentiate malignant from benign pleural diseases with sensitivity 89.3%, specificity 100%, positive predictive value 100%, negative predictive value 81.2%, and accuracy 92.68% (P < 0.001). Conclusion Although DWI-MRI is unable to differentiate between malignant and benign pleural effusion, its combined morphological and functional information provide valid non-invasive method to accurately characterize pleural soft tissue diseases differentiating benign from malignant lesions with higher specificity and accuracy than conventional MRI.

Accuracy of Medical Examiner’s Assessment for Near–Real-Time Surveillance of Fatal Drug Overdoses, King County, Washington, March 2017–February 2018

2021 ◽  
pp. 003335492110084
Author(s):  
Kirsten Vannice ◽  
Julia Hood ◽  
Nicole Yarid ◽  
Meagan Kay ◽  
Richard Harruff ◽  
...  
Keyword(s):  
Public Health ◽  
Positive Predictive Value ◽  
Real Time ◽  
Negative Predictive Value ◽  
Drug Overdose ◽  
Predictive Value ◽  
Death Certificate ◽  
King County ◽  
Public Health Response ◽  
Drug Overdoses

Objectives Up-to-date information on the occurrence of drug overdose is critical to guide public health response. The objective of our study was to evaluate a near–real-time fatal drug overdose surveillance system to improve timeliness of drug overdose monitoring. Methods We analyzed data on deaths in the King County (Washington) Medical Examiner’s Office (KCMEO) jurisdiction that occurred during March 1, 2017–February 28, 2018, and that had routine toxicology test results. Medical examiners (MEs) classified probable drug overdoses on the basis of information obtained through the death investigation and autopsy. We calculated sensitivity, positive predictive value, specificity, and negative predictive value of MEs’ classification by using the final death certificate as the gold standard. Results KCMEO investigated 2480 deaths; 1389 underwent routine toxicology testing, and 361 were toxicologically confirmed drug overdoses from opioid, stimulant, or euphoric drugs. Sensitivity of the probable overdose classification was 83%, positive predictive value was 89%, specificity was 96%, and negative predictive value was 94%. Probable overdoses were classified a median of 1 day after the event, whereas the final death certificate confirming an overdose was received by KCMEO an average of 63 days after the event. Conclusions King County MEs’ probable overdose classification provides a near–real-time indicator of fatal drug overdoses, which can guide rapid local public health responses to the drug overdose epidemic.

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