scholarly journals Current Practice of Hospital Acquired Thrombosis (HAT) Prevention in an Acute Hospital (a single centre cross sectional study)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4459-4459 ◽  
Author(s):  
Dr. Muhammad Irfan Khan ◽  
Catriona O'Leary ◽  
Mary Ann Hayes ◽  
Patricia O'Flynn ◽  
Pauline Suzanne Chappell ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Assessment Tool ◽  
Drug Prescription ◽  
National Policy ◽  
Significant Risk ◽  
Low Risk ◽  
Risk Assessment Tool ◽  
Risk Category ◽  
High Risk Category

Abstract Background Evidence based consensus guidelines for venous thromboembolism (VTE) prevention are broadly accepted to be effective and safe for more than three decades (Clagett GP et al, 1992). However VTE continues to be associated with a major global burden of disease with 3.9 million cases of HAT during one year among 1.1 billion citizens of high income countries (Jha AK et al, 2013). Therefore prevention is the key to reduce death and disability resulting from VTE (Kahn S et al, Gould MK et al & Falck-Yitter Y et al, 2012). Ireland like many other countries has yet to implement a mandatory risk assessment tool and thromboprophylaxis (TP) policy nationally. Aims The aim of this study was to calculate the proportion of inpatients who had a VTE risk assessment performed and received appropriate TP in a large tertiary referral hospital. This information will be vital for baseline data for implementation of a new national policy for prevention of HAT. Methods This audit was performed at Cork University Hospital on 4 pre specified days between November 2014 to February 2015. All adult inpatients (Medical and Surgical) excluding maternity and psychiatric were included. Patients on therapeutic anticoagulation were also excluded. The patients' medical chart and drug prescription chart were reviewed to determine whether or not a VTE risk assessment was documented for each patient and if they had received appropriate TP. If no risk assessment had been performed, trained researchers applied the National Institute for health and Care Excellence (NICE) guidelines 92 (Jan 2010) for VTE risk assessment and prevention. Following the risk assessment patients were divided into three categories, high risk of VTE with low risk of bleeding; high risk of VTE with significant risk of bleeding and low risk of VTE. From this the proportion of patients in each group that received appropriate TP were calculated. Results A total of 1019 patients were enrolled the majority were medical patients 63.5% (n=648). The mean age of patients was 69 years. Females accounted for 52% of patients. Average length of hospitalisation for each patient at the time of the audit was 6 days (range 1-664 days). Overall, a formal TP risk assessment was documented in only 24% (n=244) of all charts reviewed however TP was prescribed in 43.2% (n=441) of patients. See table.Table 1.High Risk of VTE low risk of bleedingHigh risk of VTE significant risk of bleedingLow risk of VTENo. of pts80.3% (n=819)16.6% (n=170)2.9% (n=30)VTE risk assessment documented21.9% (n=180)28.2% (n=55)30% (n=9)Received TP46.3% (n=380)28.8% (n=49)40% (n=12) Within the high risk category patients, 64.3% (n=526) medical. TP was only administered to 46.3% (n=380) of patients in the high risk category. This was almost evenly distributed between surgical 50.1% (n=147) and medical 43.4% (n=233) patients. Conclusion This audit was done as the initial step to develop a national policy to prevent HAT. As suspected, this audit highlights that a large proportion of hospitalised patients, both surgical and medical, continue to be at high risk for VTE despite the availability of preventative measures. There is clear illustration of under prescription of safe, effective and recommended means of VTE prevention. The current overall figure of less than 50% prescription of VTE thromboprophylaxis in high risk patients is a major patient safety concern. There are numerous recognised international guidelines for prevention of VTE, and an efficient method to implement these guidelines needs to be developed. Beyond developing national guidelines for TP, we need a co-ordinated approach to implement and monitor compliance with guidelines. Once the preliminary results of this audit were available to us in March 2015, urgent measures were taken to reduce the identified risk such as the establishment of a Hospital Thrombosis Group which developed a user friendly VTE risk assessment tool and TP policy. The VTE risk assessment tool was incorporated into the patients drug prescription chart and included a pre printed prescription for TP. It is now mandatory for the all patients to have a VTE risk assessment tool and TP prescribed if appropriate within 24hrs of admission. This was successfully piloted for four weeks in the acute medical assessment unit and is now incorporated into each patients drug chart throughout the hospital. This audit will be replicated in 6 months from introduction of this initiative, with an aim of >90% compliance. Disclosures No relevant conflicts of interest to declare.

Hemorrhage Risk Assessment on Admission: Utility for Prediction of Maternal Morbidity

2020 ◽  
Author(s):  
Homa K. Ahmadzia ◽  
Jaclyn M. Phillips ◽  
Rose Kleiman ◽  
Alexis C. Gimovsky ◽  
Susan Bathgate ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Blood Transfusion ◽  
Maternal Morbidity ◽  
Assessment Tool ◽  
Low Risk ◽  
Risk Assessment Tool ◽  
Maternal Outcomes ◽  
Hemorrhage Risk ◽  
Low Risk Women

Objective Hemorrhage is a major cause of maternal morbidity and mortality prompting creation of innovative risk assessment tools to identify patients at highest risk. We aimed to investigate the association of hemorrhage risk assessment with maternal morbidity and to evaluate maternal outcomes after implementation of the risk assessment across hospital sites. Study Design We conducted a retrospective cohort analysis of a multicenter database including women admitted to labor and delivery from January 2015 to June 2018. The Association of Women's Health, Obstetric and Neonatal Nurses risk assessment tool was used to categorize patients as low, medium, or high risk for hemorrhage. Multivariate logistic regression was used to describe the association between hemorrhage risk score and markers of maternal morbidity and evaluate maternal outcomes before and after standardized implementations of the risk assessment tool. Results In this study, 14,861 women were categorized as low risk (26%), 26,080 (46%) moderate risk, and 15,730 (28%) high risk (N = 56,671 births). For women with high-risk scores, the relative risk (RR) ratio compared with low-risk women was 4.9 (RR: 95% confidence interval [CI]: 3.2–7.4) for blood transfusion and 5.2 (RR: 95% CI: 4.6–5.9) for estimated blood loss (EBL) ≥ 1,000 mL. For the second objective, 110,633 women were available for pre- and postimplementation analyses (39,027 and 71,606, respectively). A 20% reduction in rates of blood transfusion (0.5–0.4%, p = 0.02) and EBL ≥ 1,000 mL (6.3–5.9%, p = 0.014) was observed between pre- and postimplementations of the admission hemorrhage risk assessment tool. Conclusion Women who were deemed high risk for hemorrhage using a hemorrhage risk assessment tool had five times higher risk for blood transfusion and EBL ≥ 1,000 mL compared with low-risk women. Given the low incidence of the outcomes explored, the hemorrhage risk assessment works moderately well to identify patients at risk for peripartum morbidity. Key Points

scholarly journals 1277Reasons for quarantine and positivity rate among quarantined Health Care Workers (HCWs) in North India

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Naveen Prashar ◽  
Rahuldeep Singh ◽  
Ritin Mohindra ◽  
Vikas Suri ◽  
Ashish Bhalla ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Assessment Tool ◽  
Risk Groups ◽  
Low Risk ◽  
North India ◽  
Risk Exposure ◽  
P Value ◽  
Risk Category ◽  
Personal Protection Equipment

Abstract Background WHO has declared the COVID-19 as Pandemic on 11th March, 2020. It is important to break the chain of transmission by quarantining the persons with high-risk exposure. Understanding the reasons for quarantine will help in reducing the exposures and thus reducing the chances of quarantine. Methods A validated risk assessment tool based on National Centre for Disease Control guidelines was used for the risk assessment of HCWs. The forms of HCWs who underwent risk assessment between April-November, 2020 were analyzed for reasons of quarantine. The positivity rates among high-risk and low-risk groups were compared. Results Out of 1414 HCWs who were assessed, 345 were categorized as high-risk exposure and were quarantined. The most common reasons for quarantine were performance of aerosol generating procedure without recommended personal protection equipment (PPE) (34%), exposure to COVID-19 positive patient without mask for more than 20 minutes at the distance less than 1 m (30%) and having food/tea together (27%). The positivity rate was 8.4% among high-risk and 1.9% among low-risk exposure group (p-value: <0.001). The positivity among low risk category was more in the second half (19/466; 4.1%) as compared to first half (1/603; 0.2%) of the study period. This might be due to exposure from non-hospital sources as second half coincides with first wave of the pandemic. Conclusion Not using recommended PPE and having tea/food breaks together were the most common reasons for quarantine. Key messages Strict enforcement of recommended PPE and scattered tea and food breaks can reduce high-risk exposures.

scholarly journals Obstetric hemorrhage risk assessment tool predicts composite maternal morbidity

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Emer L. Colalillo ◽  
Andrew D. Sparks ◽  
Jaclyn M. Phillips ◽  
Chinelo L. Onyilofor ◽  
Homa K. Ahmadzia
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Prediction ◽  
Maternal Morbidity ◽  
Assessment Tool ◽  
The United States ◽  
Low Risk ◽  
Risk Assessment Tool ◽  
Obstetric Hemorrhage ◽  
Hemorrhage Risk

AbstractObstetric hemorrhage is one of the leading preventable causes of maternal mortality in the United States. Although hemorrhage risk-prediction models exist, there remains a gap in literature describing if these risk-prediction tools can identify composite maternal morbidity. We investigate how well an established obstetric hemorrhage risk-assessment tool predicts composite hemorrhage-associated morbidity. We conducted a retrospective cohort analysis of a multicenter database including women admitted to Labor and Delivery from 2016 to 2018, at centers implementing the Association of Women’s Health, Obstetric, and Neonatal Nurses risk assessment tool on admission. A composite morbidity score incorporated factors including obstetric hemorrhage (estimated blood loss ≥ 1000 mL), blood transfusion, or ICU admission. Out of 56,903 women, 14,803 (26%) were categorized as low-risk, 26,163 (46%) as medium-risk and 15,937 (28%) as high-risk for obstetric hemorrhage. Composite morbidity occurred at a rate of 2.2%, 8.0% and 11.9% within these groups, respectively. Medium- and high-risk groups had an increased combined risk of composite morbidity (diagnostic OR 4.58; 4.09–5.13) compared to the low-risk group. This established hemorrhage risk-assessment tool predicts clinically-relevant composite morbidity. Future randomized trials in obstetric hemorrhage can incorporate these tools for screening patients at highest risk for composite morbidity.

P1803Refining the 2015 European guidelines risk assessment tool for pulmonary arterial hypertension in adult congenital heart disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A C Van Dissel ◽  
A P J Van Dijk ◽  
A L Duijnhouwer ◽  
B J M Mulder ◽  
B J Bouma
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Congenital Heart ◽  
Assessment Tool ◽  
Risk Groups ◽  
Low Risk ◽  
Risk Assessment Tool ◽  
Intermediate Risk ◽  
European Guidelines ◽  
Pulmonary Arterial

Abstract Background Current European guidelines advocate a goal-oriented treatment approach in pulmonary arterial hypertension (PAH), based on a comprehensive risk assessment. However, this instrument has been based predominantly on patients with idiopathic PAH and its accuracy has not been well established for PAH associated with congenital heart disease (CHD)–a patient population known to be distinctly different for other PAH aetiologies. Purpose To investigate the discriminatory ability of the guidelines risk assessment tool and explore the benefit of including other cut-offs or variables in PAH-CHD. Methods and results Data from 112 PAH-CHD patients (age 42.1±16 years, 70% Eisenmenger, 38% Down syndrome) seen between 2004 and 2016 at two specialized adult PAH-CHD expert centres were prospectively collected. Patients were classified as “Low”, “Intermediate”, or “High” risk following the strategy proposed by Kylhammar (Eur Heart J, 2017) based on N-terminal pro-brain natriuretic peptide (NT-proBNP), 6-minute walk distance, functional class and imaging parameters and analysed by Kaplan-Meier method, truncated at 5 years. At baseline, 25% (28) of patients were classified as “Low risk”, 69% (77) as “Intermediate risk” and 6% (7) as “High risk”. Although survival was better (P=0.012) for patients with higher proportions of “Low risk” variables, this method did not discriminate well between the three risk groups (Figure 1A, P=0.371). One-year survival estimates corresponded moderately to those proposed by the guidelines, 96.4% in the “Low risk” (vs. >95%), 94.8% in the “Intermediate risk” (vs. 90–95%), and 85.7% in the “High risk” (vs. <90%) baseline cohorts, respectively. Analysis of different cut-off values for NT-proBNP (i.e., “Low”, “Intermediate”, “High” as <500, 500–1440 and >1400 ng/l, respectively) and use of tricuspid annular plane systolic excursion (TAPSE) measurements (“Low”, “Intermediate”, “High” as <1.6, 2.6–2.7 and >2.7 cm, respectively) as imaging parameter instead of right atrial area improved discrimination between the risk groups (Figure 1B). With these adjustments to the risk assessment tool, survival differed between all three risk groups (P<0.001). Figure 1 Conclusion Our preliminary findings suggest that an updated version of the European guidelines risk assessment tool–with different cut-off values for NT-proBNP and use of TAPSE–discriminates more accurately in the PAH-CHD population. Further analysis will be performed to estimate the prognostic benefit of reaching a “Low risk” profile, as this is the recommended treatment goal.

scholarly journals Choice of a suitable diabetes risk assessment tool in Nepal – can we learn from Canada?

2016 ◽  
Vol 6 (2) ◽  
pp. 548-550
Author(s):  
Gina Agarwal ◽  
Brijesh Sathian ◽  
Sutapa Agrawal
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Health Outcomes ◽  
Assessment Tool ◽  
National Policy ◽  
Diabetes Risk ◽  
Risk Assessment Tool ◽  
Educational Tool ◽  
Diabetes Risk Factors ◽  
The Masses

If the population can be made more aware about diabetes by the use of a risk assessment tool as an educational tool as well, it could help to curb the diabetes epidemic in Nepal. Education of the masses about diabetes risk factors, prevention, and complications is urgently needed, using clear and simple messages. National policy efforts can be strengthened and health  outcomes improved when awareness is increased. Perhaps learning from Canada is a start, and Nepal will be able to make progress with something simple like ‘NEPAL-RISK’?

scholarly journals TYPE 2 DIABETES MELLITUS PREDICTION IN MALAYSIA USING MODIFIED DIABETES RISK ASSESSMENT TOOL

2020 ◽  
Vol 20 (1) ◽  
pp. 15-21
Author(s):  
Aung Myo Oo ◽  
Al-abed Ali Ahmed Al-abed ◽  
Ohn Mar Lwin ◽  
Sowmya Sham Kanneppady ◽  
Tee Yee Sim ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Risk Assessment ◽  
Type 2 Diabetes Mellitus ◽  
High Risk ◽  
Assessment Tool ◽  
Cost Effective ◽  
Risk Assessment Tool ◽  
Type 2 Dm

Type 2 diabetes mellitus (DM) is becoming major health threat worldwide and it is extremely common in clinical setting. Malaysia is one of the highest diabetic populations among Asian countries and the new cases are increasing day to day. Early detection of people with high risk of Type 2 DM by using simple, easy and cost-effective assessment tool is the better way to identify and prevent the community from this non-communicable disease. The objectives of the study were to identify those are high risk to become type 2DM among Malaysians by using risk scoring form and to educate them how to prevent it. Total 591 subjects were recruited from the health screening programs carried out by the collaboration of Petaling Jaya Development Council (MBPJ) and Lincoln University College, Malaysia. Modified form of Finnish Type 2 Diabetes Risk Assessment Tool was used to identify people at risk of becoming type 2 DM. Descriptive analysis was performed for all included variables in this study by using SPSS version 21. The study found out that almost half of the participants were found to have family history of DM, 60% of them were overweight and obese and 47% were having above normal waist circumference. We observed that nearly 60 % of participants in the study were having moderate to high risk of becoming type 2 DM in next 10 years. To conclude, the result of our study would be helpful in implementation of cost-effective, convenient Type 2 DM risk assessment tool which has yet to be implemented in Malaysia.

Immunoscore clinical utility to identify good prognostic colon cancer stage II patients with high-risk clinico-pathological features for whom adjuvant treatment may be avoided.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 487-487 ◽  
Author(s):  
Jerome Galon ◽  
Fabienne Hermitte ◽  
Bernhard Mlecnik ◽  
Florence Marliot ◽  
Carlo Bruno Bifulco ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Colon Cancer ◽  
High Risk ◽  
Assessment Tool ◽  
Tnm Classification ◽  
Low Risk ◽  
Stage Ii ◽  
Pathological Feature ◽  
Prognostic Features ◽  
Risk Patients

487 Background: Immunoscore Colon is an IVD test predicting the risk of relapse in early-stage colon cancer (CC) patients, by measuring the host immune response at the tumor site. It is a risk-assessment tool providing independent and superior prognostic value than the usual tumor risk parameters and is intended to be used as an adjunct to the TNM classification. Risk assessment is particularly important to decide when to propose an adjuvant (adj.) treatment for stage (St) II CC patients. High-risk stage II patients defined as those with poor prognostic features including T4, lymph nodes < 12, poor differentiation, VELIPI, bowel obstruction/perforation can be considered for adj. chemotherapy (CT). However, additional risk factors are needed to guide treatment decisions. Methods: A subgroup analysis was performed on the St II untreated patients (n = 1130) from the Immunoscore international validation study (Pagès The Lancet 2018). The high-risk patients (with at least 1 clinico-pathological high-risk feature) were classified in 2 categories using pre-defined cutoffs: Low Immunoscore versus High Immunoscore and their five-year time to recurrence (5Y TTR) was compared to the TTR of the low-risk patients (without any clinico-pathological high-risk feature). Results: Among the patients with high-risk features (n = 630), 438 (69.5%) had a High Immunoscore with a corresponding 5Y TTR of 87.4 (95% CI 83.9-91.0), statistically similar (logrank pv not stratified p > 0.42, wald pv stratified by center p > 0.20) to the TTR 89.1 (95% CI 86.1-92.1) observed for the 500 low-risk patients (with no clinico-pathological feature). Furthermore, 5Y TTR for these patients were statistically similar to those of St II patients with high-risk features and a High Immunoscore (n = 438), who received adj. CT (n = 162) (5Y TTR of 83.4 (95% CI 77.6-89.9). Conclusions: These data show that despite the presence of high-risk features that usually trigger adj. treatment, when not treated with CT, a significant part of these patients (69.5%) have a recurrence risk similar to the low risk patients. Therefore, the Immunoscore test could be a good tool for adj. treatment decision in St II patients.

O20 Quick, simple and just as effective—comparing pm: L3 ratio to NELA, P-POSSUM and NSQIP scores in assessing mortality risk for emergency laparotomy

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
J Y Ming ◽  
M Holmes ◽  
P Pockney ◽  
J Gani
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Assessment Tool ◽  
Risk Assessment Tool ◽  
Emergency Laparotomy ◽  
Routine Practice ◽  
High Risk Patients ◽  
Acs Nsqip ◽  
Psoas Muscles ◽  
Risk Patients

Abstract Introduction Multiple tools (NELA, P-POSSUM, ACS-NSQIP) are available to assess mortality risks in patients requiring emergency laparotomy(1–3), but they are time-consuming to perform and have had limited uptake in routine clinical practice in many countries(4). Simpler measures, including psoas muscle: L3 vertebrae (PM: L3) ratio(5,6), may be useful alternates. This measure is quick to perform, requiring no special skills or equipment apart from basic CT viewing software. Method We performed an analysis on all patients in the Hunter Emergency Laparotomy Audit (HELA) database, from January 2016 to December 2017. HELA is a retrospective review of all emergency laparotomy undertaken in a discrete area in NSW, Australia. Patients with an available CT abdomen were included (N = 500/562). A single slice axial CT image at the L3 endplate level was analysed using ImageJ® software to measure the area of L3 and bilateral psoas muscles. This can be done using normal PACS software in routine practice. Result PM: L3 ratios in this cohort have a mean of 1.082 (95%CI 1.042–1.122; range 0.141–3.934). PM: L3 ratio is significantly lower (P &lt; 0.00001) in those patients who did not survive beyond 30 days (mean 0.865 [95% CI 0.746–0.984]) and 90 days (mean 0.888 [95%CI 0.768–1.008]) compared to patients that survived these periods (30 day mean 1.106 [95% vs. 1.033–1.179], 90 day mean 1.112 [95% CI 1.070–1.154]). These associations are similar to those calculated by established risk assessment models. Conclusion PM: L3 ratio is a reliable, quick and easy risk assessment tool to identify high risk patients undergoing emergency laparotomy. Take-home Message PM: L3 ratio is a reliable, quick and easy risk assessment tool to identify high risk patients undergoing emergency laparotomy. It is comparable to NELA, P-POSSUM and ACS-NSQIP.

scholarly journals Predicting complication risk in spine surgery: a prospective analysis of a novel risk assessment tool

2017 ◽  
Vol 27 (1) ◽  
pp. 81-91 ◽  
Author(s):  
Anand Veeravagu ◽  
Amy Li ◽  
Christian Swinney ◽  
Lu Tian ◽  
Adrienne Moraff ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Stratification ◽  
Spine Surgery ◽  
Assessment Tool ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Acs Nsqip ◽  
Medium Risk

OBJECTIVEThe ability to assess the risk of adverse events based on known patient factors and comorbidities would provide more effective preoperative risk stratification. Present risk assessment in spine surgery is limited. An adverse event prediction tool was developed to predict the risk of complications after spine surgery and tested on a prospective patient cohort.METHODSThe spinal Risk Assessment Tool (RAT), a novel instrument for the assessment of risk for patients undergoing spine surgery that was developed based on an administrative claims database, was prospectively applied to 246 patients undergoing 257 spinal procedures over a 3-month period. Prospectively collected data were used to compare the RAT to the Charlson Comorbidity Index (CCI) and the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator. Study end point was occurrence and type of complication after spine surgery.RESULTSThe authors identified 69 patients (73 procedures) who experienced a complication over the prospective study period. Cardiac complications were most common (10.2%). Receiver operating characteristic (ROC) curves were calculated to compare complication outcomes using the different assessment tools. Area under the curve (AUC) analysis showed comparable predictive accuracy between the RAT and the ACS NSQIP calculator (0.670 [95% CI 0.60–0.74] in RAT, 0.669 [95% CI 0.60–0.74] in NSQIP). The CCI was not accurate in predicting complication occurrence (0.55 [95% CI 0.48–0.62]). The RAT produced mean probabilities of 34.6% for patients who had a complication and 24% for patients who did not (p = 0.0003). The generated predicted values were stratified into low, medium, and high rates. For the RAT, the predicted complication rate was 10.1% in the low-risk group (observed rate 12.8%), 21.9% in the medium-risk group (observed 31.8%), and 49.7% in the high-risk group (observed 41.2%). The ACS NSQIP calculator consistently produced complication predictions that underestimated complication occurrence: 3.4% in the low-risk group (observed 12.6%), 5.9% in the medium-risk group (observed 34.5%), and 12.5% in the high-risk group (observed 38.8%). The RAT was more accurate than the ACS NSQIP calculator (p = 0.0018).CONCLUSIONSWhile the RAT and ACS NSQIP calculator were both able to identify patients more likely to experience complications following spine surgery, both have substantial room for improvement. Risk stratification is feasible in spine surgery procedures; currently used measures have low accuracy.

scholarly journals A114 DEVELOPING AND VALIDATING A PATIENT RISK ASSESSMENT TOOL TO PREDICT POST-ERCP PANCREATITIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 93-94
Author(s):  
R A MacMillan ◽  
T Ponich
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
High Risk ◽  
Screening Tool ◽  
Assessment Tool ◽  
Health Science ◽  
Risk Assessment Tool ◽  
Risk Screening ◽  
Preventative Measures ◽  
Prophylactic Measures

Abstract Background Post-ERCP pancreatitis (PEP), the most common complication of ERCP, can lead to significant patient morbidity and even mortality. Both American (ASGE) and European (ESGE) guidelines emphasize the importance of assessing PEP risk among patients about to undergo ERCP so appropriate preventative measures can be initiated. Though multiple PEP risk factors have been identified, an ideal risk assessment tool has not yet been developed that accurately predicts PEP risk among ERCP patients. An ideal PEP risk factor screening tool would be one that most sensitively identifies patients likely to benefit from PEP preventative measures. We have developed a patient PEP risk screening tool based on both ASGE and ESGE guidelines (Table 1) and analyzed its accuracy predicting PEP rates in our clinical practice. Aims We investigated whether the ERCP patient and procedural risk factors listed in the ASGE and ESGE guidelines were linked to PEP rates using a novel PEP risk screening tool in patients undergoing ERCP. Methods Retrospective chart reviews of patients undergoing ERCP were performed within a single clinician’s practice at the London Health Science Centre, Victoria Hospital, between January 2016 and October 2019 to: 1) assess the proportion of patients identified as high PEP risk using our novel PEP risk screening tool; 2) determine whether a high PEP risk score using this tool was linked to higher PEP rates following ERCP; and 3) identify the absolute score threshold that best delineates patients at higher risk. A chi-square test of independence was performed to examine the relationship between high PEP risk identified via screening and the actual PEP rate following ERCP. Results Five hundred sixty-one patients who underwent ERCP were assessed using the new PEP risk screening tool. Among those patients, 6.6% (37/561) developed post-ERCP pancreatitis. Using the screening tool, 79.5% (446/561) were identified as high risk, using a cut-off score of 1; the score with the highest sensitivity (95%) and specificity (22%) combination. Identifying high PEP risk patients at this cut-off was significantly linked to increased PEP rates in patients who underwent ERCP (X2 = 5.5; df = 1, p &lt; .05). Conclusions Using a cut-off score of 1, the PEP risk screening tool was very sensitive, but relatively non-specific at identifying patients who went on to develop post-ERCP pancreatitis. We hope that, based on these findings, high-risk patient identification can be improved, so more aggressive and appropriately-targeted prophylactic measures against PEP can be provided. Funding Agencies None

Sign in / Sign up

Export Citation Format

Share Document