Usefulness of routine chest X-ray in preoperative evaluation of patients undergoing non-cardiopulmonary surgery: a prospective observational study

2012 ◽  
Vol 29 ◽  
pp. 16 ◽  
Author(s):  
M. Kovacevic ◽  
T. Goranovic ◽  
A. Markic ◽  
M. Jelisavac ◽  
I. Zuric ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Preoperative Evaluation ◽  
X Ray ◽  
Chest X Ray ◽  
Routine Chest

scholarly journals Sensitivity of lung ultrasound for the detection of pneumothorax one day after pulmonary resection—a prospective observational study

2020 ◽  
Author(s):  
Thomas Galetin ◽  
Mark Schieren ◽  
Benjamin Marks ◽  
Jerome Defosse ◽  
Erich Stoelben
Keyword(s):  
Observational Study ◽  
Thoracic Surgery ◽  
Test Performance ◽  
Prospective Observational Study ◽  
Lung Ultrasound ◽  
Lung Resection ◽  
X Ray ◽  
Therapeutic Decisions ◽  
Chest X Ray ◽  
Diagnostic Test Performance

Summary Background Chest X‑ray (CXR) after thoracic surgery contributes to patient discomfort and costs and is of limited therapeutic value. Lung ultrasound (LU) for pneumothorax may be an alternative to CXR, but diagnostic accuracy data are heterogeneous and biased by insufficient sonographic technique and patient selection. Reported sensitivities range from 0.21 to 1.0. We evaluated the sensitivity of LU on the first day after thoracic surgery under routine conditions. Methods We performed a prospective observational study (trial-ID DRKS00014557). Consecutive patients undergoing lung resection received standardized LU in addition to routine CXR on the first postoperative day. Ultrasound examiner and radiologist were blinded to corresponding X‑ray and ultrasound findings. CXR was used as reference to determine diagnostic test performance of ultrasound. The conformity of sonography- and routine-based therapeutic decisions was evaluated. Results A total of 68 patients were examined. The mean duration of ultrasound was 145 ± 64 s. CXR identified 23 patients with pneumothorax with a mean apex-to-cupola size of 1.5 ± 1.0 cm. Ultrasound detected 18 patients with pneumothorax. The computed sensitivity of LU was 0.48 (95% confidence interval [0.36; 0.60]). Specificity was between 0.81 and 1.0, the negative predictive value 0.76 [0.66; 0.86]. The sensitivity of CXR was 0.56 [0.44; 0.68]. Air leakage via chest tube correlated weakly with CXR (spearman’s rho = 0.26) and moderately with LU (rho = 0.43). The conformity between sonographically based recommendations and the actual therapy based on routine diagnostics was 96%. Conclusions Sensitivity of ultrasound for pneumothorax detection nearly reached CXR and resulted in equally safe patient management. Our data can serve as a pilot study for upcoming larger-scaled controlled trials.

scholarly journals Comparison of the clinical characteristics and outcomes of hospitalized adult COVID-19 and influenza patients – a prospective observational study

2020 ◽  
Author(s):  
Raija Auvinen ◽  
Hanna Nohynek ◽  
Ritva Syrjänen ◽  
Jukka Ollgren ◽  
Tuija Kerttula ◽  
...  
Keyword(s):  
Observational Study ◽  
Clinical Characteristics ◽  
Prospective Observational Study ◽  
Severe Disease ◽  
Ground Glass ◽  
Current Smoking ◽  
Public Health Policies ◽  
X Ray ◽  
Chest X Ray

AbstractObjectiveWe compared the clinical characteristics, findings and outcomes of hospitalized patients with coronavirus disease 2019 (COVID-19) or influenza to detect relevant differences.MethodsFrom December 2019 to April 2020, we recruited all eligible hospitalized adults with respiratory infection to a prospective observational study at the HUS Jorvi Hospital, Finland. Influenza and SARS-CoV-2 infections were confirmed by RT-PCR. Follow-up lasted for at least 30 days from admission.ResultsWe included 61 patients, of whom 28 were COVID-19 and 33 influenza patients with median ages of 53 and 56 years. Majority of both COVID-19 and influenza patients were men (61% vs 67%) and had at least one comorbidity (68% vs 85%). Pulmonary diseases and current smoking were less common among COVID-19 than influenza patients (5 [18%] vs 15 [45%], P=0.03 and 1 [4%] vs 10 [30%], P=0.008). In chest x-ray at admission, ground-glass opacities and consolidations were more frequent among COVID-19 than influenza patients (19 [68%] and 7 [21%], P < 0.001). Severe disease and intensive care unit (ICU) admission occurred more often among COVID-19 than influenza patients (26 [93%] vs 19 [58%], P=0.003 and 8 [29%] vs 2 [6%], P=0.034). COVID-19 patients were hospitalized longer than influenza patients (6 days [IQR 4-21] vs 3 [2-4], P<0.001).ConclusionBilateral ground-glass opacities and consolidations in chest X-ray may help to differentiate COVID-19 from influenza. Hospitalized COVID-19 patients had more severe disease, required longer hospitalization and were admitted to ICU more often than influenza patients, which has important implications for public health policies.

Can Clinical Score Be Used to Guide Investigations and Management of Infants Born Through Meconium Stained Amniotic Fluid? A Prospective Observational Study*

2019 ◽  
Vol 33 (1-4) ◽  
pp. 5-9
Author(s):  
Urvi Sanghvi ◽  
Krishna Kumar Diwakar
Keyword(s):  
Observational Study ◽  
Amniotic Fluid ◽  
Initial Phase ◽  
Prospective Observational Study ◽  
Gas Analysis ◽  
Second Phase ◽  
X Ray ◽  
Chest X Ray ◽  
Meconium Stained Amniotic Fluid

Objective: To evaluate if Downes– Vidyasagar score (Downes score) for assessing respiratory distress could be used to determine the duration for observation and requirement for investigations like chest X-ray and blood gases, in an infant born through meconium stained amniotic fluid (MSAF). Materials and Methods: Prospective observational study was done in 2 phases—the initial phase to assess the role of the Downes score and the second phase to assess if the conclusions drawn from the initial phase could be applied in clinical practice. Results: In the initial phase, a total of 285 of the 302 infants born through MSAF were included for assessing the role of Downes score. The score reduced with time and did not worsen beyond 6 h. A significant association was noted between Downes score 2 or more at beyond 6 h of life and umbilical cord pH 7.15, higher AaDO2, and chest X-ray suggestive of meconium aspiration syndrome (MAS). In the second phase, applying the criteria of clinical monitoring derived from the initial phase resulted in 75% (110/147) of infants born through MSAF being shifted to the mother’s side by 6 h of life without being subjected to any investigation, Conclusion: Radiological evaluation and blood gas analysis could be restricted to only infants with persistently high or rising Downes score beyond 6 h of life. Infants having a score of <2 by 6 h of life can be shifted to mother’s side, without any further investigations or interventions.

scholarly journals A prospective observational study depicting role of lung ultrasound in pediatric pneumonias

2021 ◽  
Vol 8 (9) ◽  
pp. 1566
Author(s):  
Ashish Saklani ◽  
Ashwani Tomar ◽  
Sumala Kapila ◽  
Shyam Lal Kaushik ◽  
Anjali Mahajan
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Lung Ultrasound ◽  
Imaging Modality ◽  
High Sensitivity ◽  
Radiation Hazard ◽  
X Ray ◽  
Under Five ◽  
Lobar Pneumonia ◽  
Chest X Ray

Background: Pneumonia is a major cause of morbidity and mortality in children under five years of age. Chest x-ray poses radiation hazard to children and thus an alternative safe imaging modality must be explored for pediatric pneumonias.Methods: This prospective observational study included all children below 18 years of age. Majority of patients were below five years of age. All clinically suspicious patients were subjected to chest x-ray and lung ultrasound (LUS). Chest x-ray was considered as imaging diagnostic standard for pneumonia. Consolidation and dynamic air bronchogram were looked on LUS.Results: A total of 55 patients were included in study with 26 (47.2%) as infants and up to 47 (85.3%) as under five children. Out of 55 cases 32 cases (58.20%) were diagnosed as lobar pneumonia while 23 (41.8%) as bronchopneumonia on chest x-ray. LUS demonstrated high sensitivity and specificity of 90.63% and 100% for lobar pneumonia and 86.96 and 90.63% for bronchopneumonia respectively. Dynamic air bronchogram sign was found in all cases of lobar pneumonia on LUS and with sensitivity of 73.91% in bronchopneumonia.Conclusions: LUS proved itself as highly sensitive and specific modality for detecting consolidation and owing to safe non ionizing nature of ultrasound, it must be considered as an alternative to chest x-ray as an imaging diagnostic tool for pediatric pneumonia.

Routine Chest X-ray Examination?

PEDIATRICS ◽  
1978 ◽  
Vol 62 (5) ◽  
pp. 859-860
Author(s):  
David H. Baker ◽  
Walter E. Berdon
Keyword(s):  
Age Group ◽  
X Ray ◽  
Chest X Ray ◽  
Routine Chest ◽  
Preoperative Chest

In reference to the article by Sane et al. entitled "Value of Preoperative Chest X-ray Examinations in Children" (Pediatrics 60:669, November 1977), we would like to know if the authors broke down the abnormalities by age group—for instance, five-year segments. If so, did a preponderance of abnormalities of any variety occur at any particular age? We believe that should be stated, as it would strengthen their thesis if there was no difference between 0 and 19 years of age.

scholarly journals Protocol for DRAUP: a deimplementation programme to decrease routine chest radiographs after central venous catheter insertion

2021 ◽  
Vol 10 (4) ◽  
pp. e001222
Author(s):  
Enyo A Ablordeppey ◽  
Byron Powell ◽  
Virginia McKay ◽  
Shannon Keating ◽  
Aimee James ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Acute Care ◽  
Imaging Modality ◽  
Phase 1 ◽  
Venous Catheter ◽  
Point Of Care Ultrasound ◽  
Central Venous ◽  
X Ray ◽  
Chest X Ray ◽  
Routine Chest

IntroductionAvoiding low value medical practices is an important focus in current healthcare utilisation. Despite advantages of point-of-care ultrasound (POCUS) over chest X-ray including improved workflow and timeliness of results, POCUS-guided central venous catheter (CVC) position confirmation has slow rate of adoption. This demonstrates a gap that is ripe for the development of an intervention.MethodsThe intervention is a deimplementation programme called DRAUP (deimplementation of routine chest radiographs after adoption of ultrasound-guided insertion and confirmation of central venous catheter protocol) that will be created to address one unnecessary imaging modality in the acute care environment. We propose a three-phase approach to changing low-value practices. In phase 1, we will be guided by the Consolidated Framework for Implementation Research framework to explore barriers and facilitators of POCUS for CVC confirmation in a single centre, large tertiary, academic hospital via focus groups. The qualitative methods will inform the development and adaptation of strategies that address identified determinants of change. In phase 2, the multifaceted strategies will be conceptualised using Morgan’s framework for understanding and reducing medical overuse. In phase 3, we will locally implement these strategies and assess them using Proctor’s outcomes (adoption, deadoption, fidelity and penetration) in an observational study to demonstrate proof of concept, gaining valuable insights on the programme. Secondary outcomes will include POCUS-guided CVC confirmation efficacy measured by time and effectiveness measured by sensitivity and specificity of POCUS confirmation after CVC insertion.With limited data available to inform interventions that use concurrent implementation and deimplementation strategies to substitute chest X-ray for POCUS using the DRAUP programme, we propose that this primary implementation and secondary effectiveness pilot study will provide novel data that will expand the knowledge of implementation approaches to replacing low value or unnecessary care in acute care environments.Ethics and disseminationApproval of the study by the Human Research Protection Office has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means.Trial registration numberClinicalTrials.gov Identifier, NCT04324762, registered on 27 March 2020.

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