Referral patterns for catheter-directed thrombolysis for iliofemoral deep venous thrombosis

2021 ◽  
pp. 026835552097728
Author(s):  
Kirtan D Patel ◽  
Alison YY Tang ◽  
Ashik DJ Zala ◽  
Rakesh Patel ◽  
Kishan R Parmar ◽  
...  
Keyword(s):  
Lower Limb ◽  
Management Option ◽  
Venous Anatomy ◽  
Nice Guidelines ◽  
Patient Demographics ◽  
Radiology Reports ◽  
Catheter Directed Thrombolysis ◽  
Nice Guidance ◽  
Icd 10 ◽  
Venous Thromboses

Objectives Post thrombotic syndrome (PTS) is a serious complication of deep venous thromboses (DVTs). PTS occurs more frequently and severely following iliofemoral DVT compared to distal DVTs. Catheter directed thrombolysis (CDT) of iliofemoral DVTs may reduce PTS incidence and severity. We aimed to determine the rate of iliofemoral DVT within our institution, their subsequent management, and compliance with NICE guidelines. Methods Retrospective review of all DVTs diagnosed over a 3-year period was conducted. Cases of iliofemoral DVT were identified using ICD-10 codes from patient notes, and radiology reports of Duplex scans. Further details were retrieved, such as patient demographics and referrals to vascular services. NICE guidance was applied to determine if patients would have been suitable for CDT. A survey was sent to clinicians within medicine to identify awareness of CDT and local guidelines for iliofemoral DVT management. Results 225 patients with lower limb DVTs were identified. Of these, 96 were radiographically confirmed as iliofemoral DVTs. The median age was 77. 67.7% of iliofemoral DVTs affected the left leg. Right leg DVTs made up 30.2% and 2.1% were bilateral DVTs. Of the 96 iliofemoral DVTs, 21 were deemed eligible for CDT. Only 3 patients (14.3%) were referred to vascular services, and 3 received thrombolysis. From our survey, 95.5% of respondents suggested anticoagulation alone as management for iliofemoral DVT. Only one respondent recommended referral to vascular services. There was a knowledge deficiency regarding venous anatomy, including superficial versus deep veins. Conclusions CDT and other mechanochemical procedures have been shown to improve outcomes of patients post-iliofemoral DVT, however a lack of awareness regarding CDT as a management option results in under-referral to vascular services. We suggest closer relations between vascular services and their “tributary” DVT clinics, development of guidelines and robust care pathways in the management of iliofemoral DVT.

Potential Benefits From Heating the High-Dose rtPA Boluses Used in Catheter-Directed Thrombolysis for Acute/Subacute Lower Limb Ischemia

2003 ◽  
Vol 10 (4) ◽  
pp. 739-744 ◽  
Author(s):  
Dimitrios K. Tsetis ◽  
Asterios N. Katsamouris ◽  
Athanasios D. Giannoukas ◽  
Adam A. Hatzidakis ◽  
Theodoros Kostas ◽  
...  
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
High Dose ◽  
Lower Limb Ischemia ◽  
Catheter Directed Thrombolysis ◽  
Potential Benefits

Do Not Forget the Distal Lower Limb Veins in Screening Patients With Spinal Cord Injuries for Deep Venous Thromboses

Angiology ◽  
2009 ◽  
Vol 61 (1) ◽  
pp. 78-81 ◽  
Author(s):  
Alfried Germing ◽  
Mahmud Schakrouf ◽  
Michael Lindstaedt ◽  
Peter Grewe ◽  
Renate Meindl ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Lower Limb ◽  
Spinal Cord Injuries ◽  
Venous Thromboses

ICD-10 Diagnostic Coding for Identifying Hospitalizations Related to a Diabetic Foot Ulcer

2021 ◽  
Vol 44 (4) ◽  
pp. E11-16
Author(s):  
Muzammil H. Syed ◽  
Mohammed Al-Omran ◽  
Jean Jacob-Brassard ◽  
Joel G. Ray ◽  
Mohamad A. Hussain ◽  
...  
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Care Hospital ◽  
Reference Standard ◽  
Diagnostic Coding ◽  
Icd 10

Purpose: To estimate the positive predictive value (PPV) of Canadian ICD-10 diagnostic coding for the identification of hospitalization related to a diabetic foot ulcer (DFU). Methods: Hospitalizations related to a neuropathic and/or ischemic DFU were identified from the Discharge Abstract Database (DAD) records of a single Canadian tertiary care hospital between April 1, 2002 and March 31, 2019. The first coding approach required a most responsible diagnosis (MRDx) code for diabetes-specific foot ulceration or gangrene (DSFUG group). Three alternative coding approaches were also considered: MRDx code for lower-limb osteomyelitis (osteomyelitis group); lower-limb ulceration (LLU group); or lower-limb atherosclerotic gangrene (atherosclerosis group)—each in conjunction with a non-MRDx DSFUG code on the same DAD record. From all eligible DAD records, random samples were drawn for each coding group. DAD records were independently compared by a masked reviewer who manually abstracted data from the entire hospital record (reference standard). The PPV and 95% CI were generated. Results: Out of 1,460 hospitalizations, a total of 300, 50, 33 and seven records were included from the DSFUG, osteomyelitis, LLU and atherosclerosis samples, respectively. Compared to the reference standard, the PPV for all 390 records was 88.5% (95% CI 84.9 to 91.5). The DSFUG group had the highest PPV (90.0%, 95% CI 86.0 to 93.2), followed by the atherosclerosis (85.7%, 95% CI 42.1 to 99.6), LLU (84.9%, 95% CI 68.1 to 94.9) and osteomyelitis (82.0%, 95% CI 68.6 to 91.4) groups. Conclusion: Based on data from a Canadian tertiary care hospital, the specified coding algorithms can be used to identify and study the management and outcomes of people hospitalized with a DFU in Ontario.

EP.FRI.771 National audit on VTE prophylaxis for lower limb injuries treated in a plaster cast

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Georgios Karagiannidis ◽  
Omar Toma
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Lower Limb ◽  
Plaster Cast ◽  
Junior Doctors ◽  
National Audit ◽  
Lower Limb Injuries ◽  
Nice Guidelines ◽  
Vte Prophylaxis ◽  
Limb Injuries

Abstract Aims Audit to assess Orthopaedic departments’ compliance with NICE guidelines on Venous thromboembolism (VTE) prophylaxis published in 2010, specifically looking at VTE practices for patients with lower limb injuries treated in a plaster cast. Methods A telephonic survey was carried out on junior doctors within orthopaedic departments of 66 hospitals across all regions of England. A questionnaire was completed regarding VTE risk assessment, prophylaxis and hospital guidelines etc. Data collected from August 2016 till February 2017. Results 83% (n = 55) of trusts routinely give VTE prophylaxis to these patients. 96% (n = 64) give Chemoprophylaxis of some sort. Formal VTE assessments are performed in 81% (n = 54) and 77% (n = 51) have a local VTE prophylaxis policy. Conclusions We conclude that Orthopaedic departments across England have increased compliance with NICE guidelines for VTE prophylaxis. However there is considerable variation in practice, especially in duration and chemoprophylaxis agent. We attribute this to the lack of specific NICE guidelines for this cohort of patients. We aim that this study can influence NICE to introduce added guidance that will standardise practice.

NICE gets tooled up

2001 ◽  
Vol 6 (4) ◽  
pp. 231-232 ◽  
Author(s):  
Valerie Beattie ◽  
Brian Hockley
Keyword(s):  
Essential Element ◽  
Clinical Governance ◽  
Audit Process ◽  
Nice Guidelines ◽  
Practical Support ◽  
Nice Guidance ◽  
Multi Level ◽  
Minimum Dataset

To date over 20 guidelines or technology appraisals have been issued. At first, it seemed implicit that these guidelines would be subject to the audit process and that NICE would provide guidance and practical support for undertaking this activity. NICE have now issued a template for the audit of NICE guidelines based on a multi‐level approach. While audit of NICE guidance is an essential element of the whole clinical governance agenda, the burden of work that this could introduce to Trusts may be unsustainable. Suggests possible alternatives to auditing NICE guidance and proposes the use of a minimum dataset and full exploitation of electronic means of data harvesting.

A Memory Clinic at a Geriatric Hospital: A Report on 577 Patients Assessed with the CAMDEX Over 9 Years

2003 ◽  
Vol 37 (3) ◽  
pp. 319-326 ◽  
Author(s):  
Joe A. Stratford ◽  
Dina Logiudice ◽  
Leon Flicker ◽  
Roslyn Cook ◽  
Wendy Waltrowicz ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
The Elderly ◽  
International Classification Of Diseases ◽  
Screening Tools ◽  
Cognitive Screening ◽  
Memory Clinic ◽  
Mental Test Score ◽  
Patient Demographics ◽  
Significant Difference ◽  
Icd 10

Objective: To report 9 years’ experience of an Australian memory clinic using the Cambridge Mental Disorders in the Elderly Examination (CAMDEX) assessment schedule, summarizing patient demographics, diagnoses at presentation and the utility of four instruments used in distinguishing patients with and without dementia. Methods: All patients seen at the clinic between December 1989 and September 1998 were assessed using the CAMDEX. Diagnoses were determined according to criteria of the International Classification of Diseases, tenth edition (ICD-10). Results: The mean age of 577 patients seen was 72.9 years and 60.8% were female. Over 40% fulfilled ICD-10 diagnostic criteria for dementia in Alzheimer's disease. A further 24% had another dementing illness. Only 28 patients were ‘normal’. There was no significant difference in the ability of the 107-item Cambridge cognitive examination, the 30-item mini-mental state examination, the 10-item abbreviated mental test score and the 26-item informant questionnaire on cognitive decline in the elderly to differentiate dementia patients from those who were normal or had functional psychiatric disorders. The four cognitive screening tools had high correlations with one another (r = −0.57 to 0.93). Conclusion: Patient demographics and diagnoses were similar to those found in other clinics. Most people who attended the memory clinic had significant cognitive or psychiatric disorders.

scholarly journals A descriptive analysis of the impact of COVID-19 on Emergency Department attendance and visit characteristics in Singapore

2021 ◽  
Author(s):  
Mei Qiu Lim ◽  
Fahad Javaid Siddiqui ◽  
Seyed Ehsan Saffari ◽  
Andrew Fu Wah Ho ◽  
Johannes Nathaniel Min Hui Liew ◽  
...  
Keyword(s):  
Emergency Department ◽  
Severe Disease ◽  
Descriptive Analysis ◽  
Circuit Breaker ◽  
Historical Period ◽  
Management Planning ◽  
Crowd Management ◽  
Patient Demographics ◽  
Icd 10 ◽  
The Impact

Abstract Background: The coronavirus disease 2019 (COVID-19) has impacted the utilisation of Emergency Department (ED) services worldwide. This study aims to describe the changes in attendance of a single ED and corresponding patient visit characteristics before and during the COVID-19 period. Methods: In a single-centre retrospective cohort study, we used descriptive statistics to compare ED attendance, patient demographics and visit characteristics during the COVID-19 period (1 January – 28 June 2020) and its corresponding historical period in 2019 (2 January – 30 June 2019). Results: Mean ED attendance decreased from 342 visits/day in the pre-COVID-19 period, to 297 visits/day in the COVID-19 period. This was accompanied by a decline in presentations in nearly every ICD-10-CM diagnosis category except for respiratory-related diseases. Notably, we observed reductions in visits by critically ill patients and severe disease presentations during the COVID-19 period. We also noted a shift in ED patient case-mix from ‘Non-fever’ cases to ‘Fever’ cases, likely giving rise to two distinct trough-to-peak visit patterns during the pre-Circuit Breaker and Circuit Breaker period. Conclusions: This descriptive study revealed distinct ED visit trends across different time periods. The COVID-19 pandemic caused a reduction in ED attendances amongst patients with low-acuity conditions and those with highest priority for emergency care. This raises concern about treatment-seeking delays and possible impact on health outcomes. The downward trend in low-acuity presentations also presents learning opportunities for ED crowd management planning in a post-COVID-19 era.

Catheter-Directed Thrombolysis of Lower Limb Thrombosis

2010 ◽  
Vol 34 (1) ◽  
pp. 25-36 ◽  
Author(s):  
Marcus J. Pianta ◽  
Kenneth R. Thomson
Keyword(s):  
Lower Limb ◽  
Catheter Directed Thrombolysis

scholarly journals ICD-10 codes are a valid tool for identification of pneumonia in hospitalized patients aged ⩾65 years

2007 ◽  
Vol 136 (2) ◽  
pp. 232-240 ◽  
Author(s):  
S. A. SKULL ◽  
R. M. ANDREWS ◽  
G. B. BYRNES ◽  
D. A. CAMPBELL ◽  
T. M. NOLAN ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Medical Record ◽  
Chest Radiograph ◽  
Predictive Value ◽  
Hospitalized Patients ◽  
Radiology Reports ◽  
Cohort Design ◽  
Icd 10 ◽  
Symptoms And Signs

SUMMARYThis study examines the validity of using ICD-10 codes to identify hospitalized pneumonia cases. Using a case-cohort design, subjects were randomly selected from monthly cohorts of patients aged ⩾65 years discharged from April 2000 to March 2002 from two large tertiary Australian hospitals. Cases had ICD-10-AM codes J10–J18 (pneumonia); the cohort sample was randomly selected from all discharges, frequency matched to cases by month. Codes were validated against three comparators: medical record notation of pneumonia, chest radiograph (CXR) report and both. Notation of pneumonia was determined for 5098/5101 eligible patients, and CXR reports reviewed for 3349/3464 (97%) patients with a CXR. Coding performed best against notation of pneumonia: kappa 0·95, sensitivity 97·8% (95% CI 97·1–98·3), specificity 96·9% (95% CI 96·2–97·5), positive predictive value (PPV) 96·2% (95% CI 95·4–97·0) and negative predictive value (NPV) 98·2% (95% CI 97·6–98·6). When medical record notation of pneumonia is used as the standard, ICD-10 codes are a valid method for retrospective ascertainment of hospitalized pneumonia cases and appear superior to use of complexes of symptoms and signs, or radiology reports.

Abstract 16110: Impact of Institutional Volume on In-hospital Mortality and Resource Utilization Among Patients With Pulmonary Embolism Treated With Catheter Directed Thrombolysis: A Population-Based Cohort Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Isaac C Meier ◽  
Beau M Hawkins ◽  
Federico Silva ◽  
TALLA ROUSAN ◽  
Mohan Edupuganti ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Population Based ◽  
Data Sets ◽  
Percutaneous Approach ◽  
Catheter Directed Thrombolysis ◽  
Procedural Volume ◽  
Icd 10 ◽  
Institutional Volume

Introduction: Catheter-directed thrombolysis (CDT) is an evolving percutaneous approach for the management of acute pulmonary embolism (PE). Contemporary data examining in-hospital outcomes in relation to procedural volume are limited. Methods: Data sets were extracted from the 2016 national readmission database. Using ICD 10 codes, a search was performed to identify all patients hospitalized with a primary or secondary diagnosis of PE who underwent CDT between 1/1/2016 and 12/31/2016. Hospitals were grouped into quartiles by CDT volume and rates of in-hospital mortality, length of stay, and cost were compared across groups. Adjusted associations were examined using multivariable logistic regression. Results and Conclusions: We identified 2,353 unique patients with PE who underwent CDT at 483 hospitals. The median (25th, 75th percentiles) number of CDT procedures per hospital was 3 (1, 6). Mortality rates were 11.4%, 5.3%, 5.6% and 3.8%, respectively, at hospitals in the 1st, 2nd, 3rd and 4th quartile of CDT procedural volume (Figure; p=0.001). Results were unchanged after multivariable adjustment. Median length of stay by quartile was as follows: 6.5, 5, 5, and 4 days (p <0.001). The median cost for the different quartiles was $28,277, $25,953, $25,896, and $23,007 (p <0.001). We found that CDT performed in patients with PE at low-volume hospitals is associated with excess mortality as well as increased length of stay and cost when compared with higher-volume centers. These findings may inform guidance for volume thresholds for utilization of CDT in the management of acute PE.

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