Abstract P389: External Validation of the 2CAN Score for Inpatient Stroke Detection

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
oleg otlivanchik ◽  
Jenny Lu ◽  
Natalie Cheng ◽  
Daniel L Labovitz ◽  
charles esenwa ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Medical Center ◽  
Academic Medical Center ◽  
External Validation ◽  
Acute Stroke Care ◽  
Metabolic Encephalopathy ◽  
Cardiac Procedure ◽  
Academic Medical

Introduction: Up to 15% of all strokes occur in patients who are already hospitalized for other conditions. A validated clinical tool to help rapidly discriminate between mimics and stroke among inpatients could greatly improve acute stroke care. Recently, the 2CAN score was developed and validated at a single Midwest academic medical center to identify inpatient strokes; a score of ≥2 was highly sensitive and specific for stroke. We sought to externally validate the 2CAN score at our institution. Methods: We conducted a retrospective cohort study of consecutive inpatient stroke codes at a single Northeast academic medical center from 7/1/2018 to 11/1/2019. Pre-specified variables, including patient demographics, vascular risk factors, and clinical features (neurological examination, vital signs, laboratory values, and final diagnoses), were abstracted from the electronic medical record. We determined the sensitivity, specificity, positive and negative predictive value of a 2CAN score ≥2 for stroke (ischemic stroke, hemorrhagic stroke, or TIA) in our cohort. The 2CAN score consists of clinical deficit score (0-3 points), recent cardiac procedure (1 point), atrial fibrillation (1 point), and code called within 24 hours of admission (1 point). We used multivariate logistic regression to identify additional determinants of stroke. Results: We identified 111 inpatient stroke codes on 110 patients, mean age 67 ± 1 year, 46.8% women, and 73.8% Black or Hispanic. Final diagnosis was stroke for 54 codes (48.6%) and mimic for 57 codes (51.3%), most commonly toxic-metabolic encephalopathy. 2CAN score ≥2 had 96.3% sensitivity, 45.6% specificity, 62.7% positive predictive value, and 92.3% negative predictive value for stroke. In a multivariable logistic regression model, only recent cardiac procedure (OR: 5.5; 95% CI: 1.1-27.5) and high clinical deficit score (OR: 3.9; 95% CI: 1.9-6.1) predicted stroke. Conclusion: The 2CAN score is externally valid and helps distinguish stroke from mimic in inpatients; having a score of <2 makes stroke very unlikely.

Abstract 18699: Negative Predictive Value of Transthoracic Echocardiography for Infective Endocarditis in the Modern Era

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Joseph A Sivak ◽  
Amit N Vora ◽  
Ann Marie Navar-Boggan ◽  
Anna L Crowley ◽  
Joseph Kisslo ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Medical Center ◽  
Academic Medical Center ◽  
Valvular Regurgitation ◽  
Native Valve ◽  
Clinical Criteria ◽  
Image Optimization ◽  
Valvular Stenosis

BACKGROUND: Transesophageal echocardiography (TEE) is often recommended to exclude infective endocarditis (IE) in patients presenting with bacteremia despite a negative transthoracic echocardiogram (TTE). Previous studies showing inadequate sensitivity of TTE for native valve endocarditis are dated, and do not reflect modern advances in ultrasound image optimization technology. We hypothesized that with current generation echocardiography technology, a TTE absent mobile echo targets and without significant valvular abnormalities would have sufficient negative predictive value to exclude IE. METHODS: The Duke Echocardiographic Database was queried from 1/1/2007 [[Unable to Display Character: &#8211;]] 2/28/2014 for TTEs performed within 7 days prior to a TEE ordered for bacteremia/endocarditis. The dominant imaging platform used for both TTE and TEE during this era was the Philips IE33, with frequent use of fundamental frequencies to enhance spatial resolution beyond that of harmonic imaging alone. TTE studies identified as having poor sound transmission were excluded. A normal TTE was defined by the demonstration of normal cardiac anatomy, at most trivial valvular regurgitation, and absence of valvular stenosis, mobile/oscillating echo targets on valves, and hardware including catheters. The demonstration of an oscillating target on TEE along with clinical criteria based on chart review defined IE. RESULTS: A total of 974 unique patients had a TTE followed by a TEE within a week. IE was suggested in 209 of these patients by TEE. Among 107 patients meeting the a priori normal criteria on TTE, 3 patients had an abnormal TEE consistent with IE. These results correspond to a negative predictive value (NPV) of 97.2% (95% C.I. 91.4% - 99.3%) for a normal TTE to exclude IE. CONCLUSIONS: In this retrospective analysis from an academic medical center echocardiography laboratory, we demonstrated that an adequate quality TTE alone in a patient with a structurally normal heart without indwelling hardware has a high NPV for IE. Current TTE image optimization approaches may obviate the need to pursue TEE in patients after a recent preceding normal TTE.

Urgency of Esophageal Foreign Body Removal: Differentiation Between Coins and Button Cell Batteries

2021 ◽  
pp. 019459982110083
Author(s):  
Arash R. Safavi ◽  
Christopher D. Brook ◽  
Osamu Sakai ◽  
Bindu N. Setty ◽  
Ann Zumwalt ◽  
...  
Keyword(s):  
Foreign Body ◽  
Predictive Value ◽  
Foreign Bodies ◽  
Medical Center ◽  
Academic Medical Center ◽  
Foreign Body Removal ◽  
Digital Radiographs ◽  
Academic Medical ◽  
Button Batteries ◽  
Control Study

Objective Coin-shaped button battery foreign bodies have a similar initial presentation to coin ingestion, but delayed retrieval of a battery from the esophagus can have devastating consequences. Variations in timing of retrieval for children with ingestion of coin foreign bodies have been reported. The study assesses the sensitivity and specificity of conventional and digital radiographs to differentiate button batteries from coin foreign bodies. Study Design 3B case control study. Study Setting Tertiary academic medical center. Methods A radiographic study of the 12 most common commercially available button batteries and 66 coins of varying international origins was performed. Foreign bodies were placed at the cervical esophagus of a cadaver, and anteroposterior (AP) and lateral conventional radiographs of the neck were obtained. Digital AP and lateral radiographs of standalone coins and batteries were also obtained. Images were blindly read by 2 otolaryngologists and 2 radiologists. Statistical analysis was performed to determine accuracy in identifying coins vs batteries. Results Using conventional radiographs to identify button batteries yielded a sensitivity of 0.88 and a specificity of 0.92 (positive predictive value [PPV] = 0.75, negative predictive value [NPV] = 0.97). Digital radiography yielded an overall sensitivity of 0.98 and specificity of 0.97 (PPV = 0.87, NPV = 0.99). Features of button batteries were only seen on AP conventional radiographs using reverse contrast. Conclusions Neither conventional nor digital radiographic imaging had perfect accuracy in identifying coins vs batteries. Features of common disc batteries were identified, which may aid in diagnosis. With potential devastating consequences from retained battery in the esophagus, emergent removal of any possible disc battery foreign body should be considered.

Evaluation of the head and neck cancer patient population and the incidence of hospitalization at an academic medical center

2017 ◽  
Vol 25 (2) ◽  
pp. 333-338 ◽  
Author(s):  
Lindsay A Hazelden ◽  
Matthew J Newman ◽  
Stephanie Shuey ◽  
Julie M Waldfogel ◽  
Victoria T Brown
Keyword(s):  
Logistic Regression ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Medical Center ◽  
Academic Medical Center ◽  
Factors Associated ◽  
Chemotherapy Agent ◽  
Academic Medical ◽  
The Impact

Purpose Patients with head and neck cancer are at risk for disease- and treatment-related toxicities that may be severe enough to require hospitalization. The risk factors associated with hospitalization in these patients are not well defined. Methods We conducted a single-center, retrospective observational study of patients with head and neck cancer receiving chemotherapy at an academic medical center infusion clinic in a one-year period. The primary objective was to characterize the head and neck cancer population at an academic medical center. Secondary objectives included describing the clinical and social factors associated with hospitalization. Results There were 109 patients with head and neck cancer included in the analysis. Of these patients, 38 (35%) were hospitalized. The factors that were significantly associated with hospitalization on univariable logistic regression were former alcohol abuse, being on a nonstandard of care chemotherapy regimen, and having a chemotherapy agent discontinued. On multivariable logistic regression, the factor that was significantly associated with hospitalization was having a chemotherapy agent discontinued. The most common reasons for hospitalization included shortness of breath/respiratory failure, fever/neutropenic fever, and infection. The most common new supportive care medications prescribed at discharge were stool softeners or laxatives and opioids. Conclusion This study identified several factors which may be useful to identify patients as high risk for hospitalization and the next steps will be to determine and study the role of the pharmacist in preventing hospitalization of these patients. Further studies are needed to assess the impact of adding a pharmacist to the head and neck cancer multidisciplinary team.

Gender differences in career progress and satisfaction in an academic medical center

2002 ◽  
Vol 2 (3) ◽  
pp. 95-104 ◽  
Author(s):  
JoAnn Manson ◽  
Beverly Rockhill ◽  
Margery Resnick ◽  
Eleanor Shore ◽  
Carol Nadelson ◽  
...  
Keyword(s):  
Gender Differences ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Career Progress
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