27 The DiPEP (Diagnosis of PE in Pregnancy) study: can clinical assessment, d-dimer or chest x-ray be used to select pregnant or postpartum women with suspected PE for diagnostic imaging?

2017 ◽  
Vol 34 (12) ◽  
pp. A878.2-A879
Author(s):  
Steve Goodacre ◽  
Kimberley Horspool ◽  
Catherine Nelson-piercy ◽  
Marian Knight ◽  
Neil Shephard ◽  
...  
Keyword(s):  
Diagnostic Imaging ◽  
Clinical Assessment ◽  
Postpartum Women ◽  
X Ray ◽  
Chest X Ray ◽  
D Dimer ◽  
In Pregnancy

Focal abnormalities

ESC CardioMed ◽  
2018 ◽  
pp. 411-412
Author(s):  
Nicola Sverzellati ◽  
Gianluca Milanese ◽  
Mario Silva
Keyword(s):  
Computed Tomography ◽  
Clinical Assessment ◽  
Lung Nodules ◽  
Technological Equipment ◽  
X Ray ◽  
Progressive Development ◽  
Software Applications ◽  
Lung Abnormalities ◽  
Challenging Tasks ◽  
Chest X Ray

Both the detection and interpretation of focal abnormalities on chest X-ray (CXR) are challenging tasks. CXR accuracy depends on the view (e.g. the supine view has limited sensitivity) and technological equipment. The detection of small focal abnormalities (e.g. lung nodules) varies between anatomical regions according to the presence of dense anatomic structures, such as the bones and the hila. The interpretation of focal abnormalities on CXR is paramount within the whole clinical assessment, because CXR findings can guide the patient’s management, or warrant further investigations, such as computed tomography. Focal lung abnormalities on CXR are still a cornerstone of diagnostic algorithms; however, the radiological approach has progressively changed in the last decade because of the progressive development of both hardware and software applications that enable sensitive detection and accurate characterization.

scholarly journals Development of Severity and Mortality Prediction Models for COVID-19 Patients at Emergency Department Including the Chest X-Ray

2020 ◽  
Author(s):  
Pilar Calvillo Batllés ◽  
Leonor Cerdá-Alberich ◽  
Carles Fonfría-Esparcia ◽  
Ainhoa Carreres-Ortega ◽  
Carlos Francisco Muñoz-Núñez ◽  
...  
Keyword(s):  
Emergency Department ◽  
Intensive Care ◽  
Lymphocyte Count ◽  
Prediction Models ◽  
Mortality Prediction ◽  
X Ray ◽  
Extent Score ◽  
Mortality Prediction Models ◽  
Chest X Ray ◽  
D Dimer

Abstract Objectives: To develop prognosis prediction models for COVID-19 patients attending an emergency department (ED) based on initial chest X-ray (CXR), demographics, clinical and laboratory parameters. Methods: All symptomatic confirmed COVID-19 patients admitted to our hospital ED between February 24th and April 24th 2020 were recruited. CXR features, clinical and laboratory variables and CXR abnormality indices extracted by a convolutional neural network (CNN) diagnostic tool were considered potential predictors on this first visit. The most serious individual outcome defined the three severity level: 0) home discharge or hospitalization ≤ 3 days, 1) hospital stay >3 days and 2) intensive care requirement or death. Severity and in-hospital mortality multivariable prediction models were developed and internally validated. The Youden index was used for model selection.Results: A total of 440 patients were enrolled (median 64 years; 55.9% male); 13.6% patients were discharged, 64% hospitalized, 6.6% required intensive care and 15.7% died. The severity prediction model included oxygen saturation/inspired oxygen fraction (SatO2/FiO2), age, C-reactive protein (CRP), lymphocyte count, extent score of lung involvement on CXR (ExtScoreCXR), lactate dehydrogenase (LDH), D-dimer level and platelets count, with AUC-ROC=0.94 and AUC-PRC=0.88. The mortality prediction model included age, SatO2/FiO2, CRP, LDH, CXR extent score, lymphocyte count and D-dimer level, with AUC-ROC=0.97 and AUC-PRC=0.78. The addition of CXR CNN-based indices slightly improved the predictive metrics for mortality (AUC-ROC=0.97 and AUC-PRC=0.83).Conclusion: The developed and internally validated severity and mortality prediction models could be useful as triage tools for COVID-19 patients and they should be further validated at different ED.

scholarly journals Recurrent spontaneous pneumothorax in pregnancy-a case report

2021 ◽  
Vol 8 (11) ◽  
pp. 3449
Author(s):  
Muhammad S. Shafique ◽  
Fatima Rauf ◽  
Hamza W. Bhatti ◽  
Noman A. Chaudhary ◽  
Muhammad Hanif
Keyword(s):  
Case Report ◽  
Spontaneous Pneumothorax ◽  
Respiratory Illness ◽  
Tube Thoracostomy ◽  
Shortness Of Breath ◽  
Past Medical History ◽  
Pleuritic Chest Pain ◽  
X Ray ◽  
Chest X Ray ◽  
In Pregnancy

Spontaneous pneumothorax during pregnancy is a rare but a serious condition. The typical symptoms of spontaneous pneumothorax include pleuritic chest pain and shortness of breath. Diagnosis is usually made on chest X-ray with abdominal shielding. Management differs according to severity and no specific guidelines are described for management of spontaneous pneumothorax in pregnancy. We report a case of a 27-year-old multigravida, with insignificant past medical history for any respiratory illness, presenting with recurrent, left sided spontaneous pneumothorax during a single pregnancy. It was managed by chest tube thoracostomy each time and patient was discharged with tube till the delivery of the fetus.

scholarly journals Selecting pregnant or postpartum women with suspected pulmonary embolism for diagnostic imaging: the DiPEP diagnostic study with decision-analysis modelling

2018 ◽  
Vol 22 (47) ◽  
pp. 1-230 ◽  
Author(s):  
Steve Goodacre ◽  
Kimberley Horspool ◽  
Neil Shephard ◽  
Daniel Pollard ◽  
Beverley J Hunt ◽  
...  
Keyword(s):  
Diagnostic Imaging ◽  
Clinical Features ◽  
Thrombin Generation ◽  
Case Control Study ◽  
Multivariable Analysis ◽  
Decision Rules ◽  
Clinical Decision ◽  
Postpartum Women ◽  
Control Study ◽  
D Dimer

Background Pulmonary embolism (PE) is a leading cause of death in pregnancy and post partum, but the symptoms of PE are common in normal pregnancy. Simple diagnostic tests are needed to select women for diagnostic imaging. Objective To estimate the accuracy, effectiveness and cost-effectiveness of clinical features, decision rules and biomarkers for selecting pregnant or postpartum women with a suspected PE for imaging. Design An expert consensus study to develop new clinical decision rules, a case–control study of women with a diagnosed PE or a suspected PE, a biomarker study of women with a suspected PE or diagnosed deep-vein thrombosis (DVT) and decision-analysis modelling. Setting Emergency departments and consultant-led maternity units. Participants Pregnant/postpartum women with a diagnosed PE from any hospital reporting to the UK Obstetric Surveillance System research platform and pregnant/postpartum women with a suspected PE or diagnosed DVT at 11 prospectively recruiting sites. Interventions Clinical features, decision rules and biomarkers. Main outcome measures Sensitivity, specificity, area under receiver operating characteristic (AUROC) curve, quality-adjusted life-years (QALYs) and health-care costs. Results The primary analysis involved 181 women with PE and 259 women without PE in the case–control study and 18 women with DVT, 18 with PE and 247 women without either in the biomarker study. Most clinical features showed no association with PE. The AUROC curves for the clinical decision rules were as follows: primary consensus, 0.626; sensitive consensus, 0.620; specific consensus, 0.589; PE rule-out criteria, 0.621; simplified Geneva score, 0.579; Wells’s PE criteria (permissive), 0.577; and Wells’s PE criteria (strict), 0.732. The sensitivities and specificities of the D-dimer measurement were 88.4% and 8.8%, respectively, using a standard threshold, and 69.8% and 32.8%, respectively, using a pregnancy-specific threshold. Previous venous thromboembolism, long-haul travel, multiple pregnancy, oxygen saturation, recent surgery, temperature and PE-related chest radiograph abnormality were predictors of PE on multivariable analysis. We were unable to derive a rule through multivariable analysis or recursive partitioning with adequate accuracy. The AUROC curves for the biomarkers were as follows: activated partial thromboplastin time – 0.669, B-type natriuretic peptide – 0.549, C-reactive protein – 0.542, Clauss fibrinogen – 0.589, enzyme-linked immunosorbent assay D-dimer – 0.668, Innovance D-dimer (Siemens Healthcare Diagnostics Products GmbH, distributed by Sysmex UK Ltd, Milton Keynes, UK) – 0.651, mid-regional pro-atrial natriuretic peptide (MRproANP) – 0.524, prothrombin fragment 1 + 2 – 0.562, plasmin-antiplasmin – 0.639, Prothombin time – 0.613, thrombin generation lag time – 0.702, thrombin generation endogenous potential – 0.559, thrombin generation peak – 0.596, thrombin generation time to peak – 0.655, tissue factor – 0.531 and troponin – 0.597. The repeat analysis excluding women who had received anticoagulation was limited by the small number of women with PE (n = 4). The health economic analysis showed that a strategy of scanning all women with a suspected PE accrued more QALYs and incurred fewer costs than any selective strategy based on a clinical decision rule and was therefore the dominant strategy. Limitations The findings apply specifically to the diagnostic assessment of women with a suspected PE in secondary care. Conclusions Clinical features, decision rules and biomarkers do not accurately, effectively or cost-effectively select pregnant or postpartum women with a suspected PE for diagnostic imaging. Future work New diagnostic technologies need to be developed to detect PE in pregnancy. Trial registration Current Controlled Trials ISRCTN21245595. Funding details This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 47. See the NIHR Journals Library website for further project information.

scholarly journals The Role of Imaging In The Diagnosis of Pulmonary Embolism

2019 ◽  
Vol 2 (1) ◽  
pp. 57
Author(s):  
Alfian Nur Rosyid ◽  
M. Yamin ◽  
Arina Dery Puspitasari
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Gold Standard ◽  
Common Condition ◽  
X Ray ◽  
Life Threatening ◽  
Chest X Ray ◽  
Proper Diagnosis ◽  
D Dimer

Pulmonary embolism is a common condition and sometimes can be life-threatening. A proper diagnosis can reduce mortality. Some examinations are needed to diagnose pulmonary embolism, including assessing the risk factors, clinical examination, D-dimer tests, and imaging. Imaging is necessary when the previous assessment requires further investigation. There are more imaging that can be used to diagnose and assess the severity of pulmonary embolism. However, it is still controversial regarding imaging modalities for optimizing pulmonary embolism diagnose. Chest X-Ray cannot exclude pulmonary embolism, but it is needed to guide the next examinations and to find alternative diagnoses. Pulmonary Multi-Detector CT Angiography is the gold standard to diagnose pulmonary embolism.

scholarly journals Simple, fast and affordable triaging pathway for COVID-19

2020 ◽  
pp. postgradmedj-2020-138029
Author(s):  
Elizabeth Jane Eggleton
Keyword(s):  
Health Services ◽  
Viral Infection ◽  
Clinical Assessment ◽  
Blood Analysis ◽  
X Ray ◽  
Mild Disease ◽  
Global Pandemic ◽  
Chest X Ray ◽  
Severe Respiratory Infection ◽  
Laboratory Investigations

Coronavirus disease 2019 has caused a global pandemic. The majority of patients will experience mild disease, but others will develop a severe respiratory infection that requires hospitalisation. This is causing a significant strain on health services. Patients are presenting at emergency departments with symptoms of dyspnoea, dry cough and fever with varying severity. The appropriate triaging of patients will assist in preventing health services becoming overwhelmed during the pandemic. This is assisted through clinical assessment and various imaging and laboratory investigations, including chest X-ray, blood analysis and identification of viral infection with SARS-CoV-2. Here, a succinct triaging pathway that aims to be fast, reliable and affordable is presented. The hope is that such a pathway will assist health services in appropriately combating the pandemic.

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