Emergency CT misdiagnosis in acute aortic syndrome

2021 ◽  
Vol 94 (1126) ◽  
pp. 20201294
Author(s):  
John G Dreisbach ◽  
Jonathan CL Rodrigues ◽  
Giles Roditi
Keyword(s):  
False Positive ◽  
Cross Sectional Study ◽  
Health Board ◽  
Acute Aortic Syndrome ◽  
Motion Artefact ◽  
Cross Sectional ◽  
Technical Adequacy ◽  
Ct Technique ◽  
Acute Hospitals ◽  
Ct Studies

Objectives: This cross-sectional study assessed the accuracy of emergency CT reports at presentation in acute aortic syndrome (AAS). Methods: Retrospective identification of cases of AAS presenting within a large health board with three acute hospitals receiving adult patients between January 2013 and December 2016. CT studies and reports at presentation were reviewed for discrepancies related to diagnosis, complications and classification by two cardiovascular radiologists. The specialist interest of the original reporters, clinically suspected diagnosis at referral for CT and technical adequacy of the scans were also assessed. False-positive diagnoses were identified and evaluated separately. Results: Among 88 consecutive confirmed cases of AAS at least one discrepancy was identified in 31% (n = 27), including failure to identify or misinterpretation of the AAS itself in 15% (n = 13), haemorrhage in 13% (n = 11), branch involvement in 9% (n = 8), and misclassification in 3% (n = 3). All discrepancies occurred among the 80% (n = 70) of cases reported by radiologists without specialist cardiovascular interest. 26% (n = 23/88) of AAS cases were not clinically suspected at referral for CT and although this was associated with suboptimal protocols, only 51% of CT scans among suspected cases were technically adequate. Seven false-positive diagnoses were identified, three of which related to motion artefact. Conclusion: Significant discrepancies are common in the emergency CT assessment of positive cases AAS and this study highlights important pitfalls in CT technique and interpretation. The absence of discrepancies among radiologists with specialist cardiovascular interest suggests both suspected and confirmed cases warrant urgent specialist review. Advances in knowledge: CT angiography is central to the diagnosis of AAS; however, significant radiology discrepancies are common among non-specialists. This study highlights important pitfalls in both CT technique as well as interpretation and supports routine specialist cardiovascular imaging input in the emergency assessment of AAS.

scholarly journals Use of the first National Early Warning Score recorded within 24 hours of admission to estimate the risk of in-hospital mortality in unplanned COVID-19 patients: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043721
Author(s):  
Donald Richardson ◽  
Muhammad Faisal ◽  
Massimo Fiori ◽  
Kevin Beatson ◽  
Mohammed Mohammed
Keyword(s):  
Hospital Mortality ◽  
Early Warning ◽  
Absolute Risk ◽  
Cross Sectional Study ◽  
Early Warning Score ◽  
Cross Sectional ◽  
Risk Of Mortality ◽  
Baseline Mortality ◽  
Acute Hospitals ◽  
National Early Warning Score

ObjectivesAlthough the National Early Warning Score (NEWS) and its latest version NEWS2 are recommended for monitoring deterioration in patients admitted to hospital, little is known about their performance in COVID-19 patients. We aimed to compare the performance of the NEWS and NEWS2 in patients with COVID-19 versus those without during the first phase of the pandemic.DesignA retrospective cross-sectional study.SettingTwo acute hospitals (Scarborough and York) are combined into a single dataset and analysed collectively.ParticipantsAdult (≥18 years) non-elective admissions discharged between 11 March 2020 and 13 June 2020 with an index or on-admission NEWS2 electronically recorded within ±24 hours of admission to predict mortality at four time points (in-hospital, 24 hours, 48 hours and 72 hours) in COVID-19 versus non-COVID-19 admissions.ResultsOut of 6480 non-elective admissions, 620 (9.6%) had a diagnosis of COVID-19. They were older (73.3 vs 67.7 years), more often male (54.7% vs 50.1%), had higher index NEWS (4 vs 2.5) and NEWS2 (4.6 vs 2.8) scores and higher in-hospital mortality (32.1% vs 5.8%). The c-statistics for predicting in-hospital mortality in COVID-19 admissions was significantly lower using NEWS (0.64 vs 0.74) or NEWS2 (0.64 vs 0.74), however, these differences reduced at 72hours (NEWS: 0.75 vs 0.81; NEWS2: 0.71 vs 0.81), 48 hours (NEWS: 0.78 vs 0.81; NEWS2: 0.76 vs 0.82) and 24hours (NEWS: 0.84 vs 0.84; NEWS2: 0.86 vs 0.84). Increasing NEWS2 values reflected increased mortality, but for any given value the absolute risk was on average 24% higher (eg, NEWS2=5: 36% vs 9%).ConclusionsThe index or on-admission NEWS and NEWS2 offers lower discrimination for COVID-19 admissions versus non-COVID-19 admissions. The index NEWS2 was not proven to be better than the index NEWS. For each value of the index NEWS/NEWS2, COVID-19 admissions had a substantially higher risk of mortality than non-COVID-19 admissions which reflects the increased baseline mortality risk of COVID-19.

scholarly journals False Positive Rates and Associated Risk Factors on the VOMS and mBESS in U.S. Military Personnel

2021 ◽  
Author(s):  
Anthony P. Kontos ◽  
MAJ Katrina Monti ◽  
Shawn R. Eagle ◽  
MAJ Eliot Thomasma ◽  
Cyndi L. Holland ◽  
...  
Keyword(s):  
Risk Factors ◽  
Motion Sickness ◽  
Military Personnel ◽  
False Positive ◽  
False Positive Rate ◽  
Cross Sectional Study ◽  
False Positives ◽  
Chi Square ◽  
Cross Sectional ◽  
History Of

ABSTRACT Context: In 2018, the U.S. military developed the Military Acute Concussion Evaluation-2 (MACE-2) to inform acute evaluation of mTBI. However, researchers have yet to investigate false positive rates for components of the MACE-2 including the Vestibular-Ocular Motor Screen (VOMS) and modified Balance Error Scoring System (mBESS) in military personnel. Objective: To examine factors associated with false positives in VOMS and mBESS in U.S. Army Special Operations Command (USASOC) personnel. Design: Cross-sectional study. Setting: Military medical clinic. Participants: 416 healthy USASOC personnel completed medical history, VOMS, and mBESS evaluations. Main Outcome Measures: False positive rates for the VOMS (2+ on VOMS symptom item, ≥ 5 cm for near point of convergence [NPC] distance) and mBESS (total score >4) were determined using chi-square analyses and independent samples t-tests. Multivariable logistic regressions (LR) with adjusted odds ratios (aOR) were performed to identify risk factors for false positives on VOMS and mBESS. VOMS items false positive rates ranged from 10.6% (smooth pursuits) to 17.5% (NPC). mBESS total score false positive rate was 36.5%. Results: The multivariable LR model supported three significant predictors of VOMS false positives including age (OR= 1.07, 95% CI= 1.02–1.12, p=0.007), migraine (OR=2.49, 95% CI= 1.29–4.81, p=0.007), and motion sickness history (OR=2.46, 95% CI= 1.34–4.50, p=0.004). Results of the multivariable LR model supported only motion sickness history as a significant predictor (OR=2.34, 95% CI= 1.34–4.05, p=0.002) of mBESS false positives. Conclusions: There were low false positive rates across VOMS items, which were associated with age, history of mTBI, migraine, and motion sickness. False positives for the mBESS total score were higher (36.5%) and were only associated with a history of motion sickness. These risk factors for false positives should be considered when administering and interpreting VOMS and mBESS components of the MACE-2 in this population.

scholarly journals DETERMINATION OF GRAY ZONE RANGE IN HBsAg TEST AND ITS IMPLICATION FOR HBsAg CONFIRMATION TEST

2018 ◽  
Vol 24 (2) ◽  
pp. 127
Author(s):  
Vina Zakiah Latuconsina ◽  
Irda Handayani ◽  
Asvin Nurulita ◽  
Uleng Bahrun Uleng Bahrun
Keyword(s):  
False Positive ◽  
False Negative ◽  
Clinical Pathology ◽  
Cross Sectional Study ◽  
Gray Zone ◽  
Chi Square ◽  
Pathology Laboratory ◽  
Cross Sectional ◽  
Confirmation Test ◽  
Chi Square Test

Hepatitis is an inflammation of liver cells caused by infection (virus, bacteria, paracytes), medication, alcohol consumption, excessive lipid and autoimmune disease. Increasing method (sensitivity) of HBsAg test is often followed by a lot of false positive test results, which need a confirmation test which takes a longer time and higher cost so that it is needed to determine an optimal gray zone range for a confirmation test. This analytical cross-sectional study was held at the Clinical Pathology Laboratory of the Dr.Wahidin Sudirohusodo Hospital Makassar. The subjects were specimens which HBsAg value was within 0.06-1 COI. Specimens were examined using HBsAg confirmation test. Over 49 samples collected there were 32 reactive and 17 non-reactive. 14 out of 32 reactive samples (43.8%) were confirmed as negative (false positive) by HBsAg confirmation test and 3 out of 17 non-reactive samples (17.6%) were confirmed as positive (false negative). Chi-square test showed a significant correlation between HBsAg value and HBsAg confirmation test value (p=0.009). Chi-square test with some intervals with α=1% showed that the interval of HBsAg value 0.13-0.17 COI was the interval with the lowest significant value (p=0.004). This subsequent interval was recommended as the gray zone range. The range 0.13-0.17 was most optimal as HBsAg gray zone to determine the need for a confirmation test. A further study with larger samples is suggested. 

Moving and handling care of bariatric patients: a survey of clinical nurse managers

2020 ◽  
pp. 174498712097062
Author(s):  
Sara Dockrell ◽  
Graham Hurley
Keyword(s):  
Nurse Managers ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Hard Copy ◽  
Patient Handling ◽  
Cross Sectional ◽  
Clinical Nurse ◽  
Acute Hospitals ◽  
Bariatric Patients ◽  
And Training

Background The prevalence of obesity is rising, and obese persons are more likely to use healthcare services and require moving and handling care. Aims This study explored the frequency, logistics and barriers to the provision of bariatric patient-handling care including equipment availability in acute hospitals. Methods A cross-sectional study design using an anonymous 24-item questionnaire was used to survey 322 clinical nurse managers. Completed hard-copy questionnaires ( n = 132) were returned by post. Results Most clinical nurse managers (93.1%) provided care for bariatric patients and 85.6% reported barriers to the provision of bariatric care within their clinical area. The principal barriers were lack of equipment (75%), staff (65.2%) and training (57.6%). Only 11.4% owned all the required equipment. Owning equipment provided significantly greater access to a hoist ( P = 0.001) and chair ( P = 0.032) than renting. Only 9.5% reported that rented equipment always arrives on time. The majority (74.4%) did not have guidelines for caring for bariatric patients, and 46.2% considered this to be a barrier. Conclusions Barriers to caring for bariatric patients were identified. Most of the equipment was rented, and significant delays in its delivery were reported. The need for education and training and the dissemination of policies and guidelines were identified.

scholarly journals Increasing false positive diagnoses may lead to overestimation of stroke incidence, particularly in the young: a cross-sectional study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Abhinav J. Appukutty ◽  
Lesli E. Skolarus ◽  
Mellanie V. Springer ◽  
William J. Meurer ◽  
James F. Burke
Keyword(s):  
Older Adults ◽  
False Positive ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Primary Diagnosis ◽  
Sectional Study ◽  
Cross Sectional ◽  
Stroke Incidence ◽  
Ed Visits ◽  
Over Time

Abstract Background Stroke incidence is reportedly increasing in younger populations, although the reasons for this are not clear. We explored possible reasons by quantifying trends in neurologically focused emergency department (ED) visits, classification of stroke vs. TIA, and imaging use. Methods We performed a retrospective, serial, cross-sectional study using the National Hospital Ambulatory Medical Care Survey to examine time trends in age-stratified primary reasons for visit, stroke/TIA diagnoses, and MRI utilization from 1995 to 2000 and 2005–2015. Results Five million eight hundred thousand ED visits with a primary diagnosis of stroke (CI 5.3 M–6.4 M) were represented in the data. The incidence of neurologically focused reason for visits (Neuro RFVs) increased over time in both the young and in older adults (young: + 111 Neuro RFVs/100,000 population/year, CI + 94 − + 130; older adults: + 70 Neuro RFVs/100,000 population/year, CI + 34 − + 108). The proportion of combined stroke and TIA diagnoses decreased over time amongst older adults with a Neuro RFV (OR 0.95 per year, p < 0.01, CI 0.94–0.96) but did not change in the young (OR 1.00 per year, p = 0.88, CI 0.95–1.04). Within the stroke/TIA population, no changes in the proportion of stroke or TIA were identified. MRI utilization rates amongst patients with a Neuro RFV increased for both age groups. Conclusions We found, but did not anticipate, increased incidence of neurologically focused ED visits in both age groups. Given the lower pre-test probability of a stroke in younger adults, this suggests that false positive stroke diagnoses may be increasing and may be increasing more rapidly in the young than in older adults.

Performance of Malaria Microscopy External Quality Assessment and networking among Health Facilities in West Amhara Region, Ethiopia

2020 ◽  
Author(s):  
Banchamlak Tegegne ◽  
Kefale Ejigu ◽  
Getaneh Alemu ◽  
Yeshimebet Fetene ◽  
Kindye Endaylalu ◽  
...  
Keyword(s):  
Microscopic Examination ◽  
False Positive ◽  
False Negative ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
Reference Laboratory ◽  
Amhara Region ◽  
Good Test ◽  
Cross Sectional ◽  
Malaria Microscopy

Abstract Background: In most health facilities, microscopic examination of peripheral blood smears is performed for definitive diagnosis of malaria. Despite it produces reliable results about both the infection status and level of parasitemia, microscopic examination of malaria is affected by skill of the laboratory personnel, workload, condition of microscopes and quality of laboratory supplies. Therefore, continuous monitoring of the performance of laboratories is critical in order to make timely corrections. Objective: To assess malaria microscopy performance of diagnostic laboratories in west Amhara region.Methods: A facility based cross-sectional study was conducted from July 2017 to July 2019 among thirty malaria diagnostic laboratories in west Amhara region. Thirty slides were collected from participating laboratories every quarter. Collected slides were taken to Amhara Public Health Institute (APHI) reference laboratory and re-checked by malaria microscopist who were blind to the results from health facilities. Percentage of test agreement, rates of false positive, false negative and species misdiagnosis were calculated using Excel 2010.Results: Among a total of 6689 slides re-examined, results of 6146 slides were the same with that of participating laboratories to give a test agreement of 97.31% and 94.6% in parasite detection and species identification, respectively. Variations in the overall performance of individual laboratories were seen within a range of 81.55% to 97.27% test agreement. Results of 543 (8.12%) slides were discordant, of which 363 (5.4%), 93 (1.4%) and 87 (1.3%) were due to species misdiagnosis, false positive and false negative results, respectively. Conclusion: There was good test agreement between participated laboratories and APHI laboratory. More accurate performance is expected as the country is tracking to malaria elimination. Hence, strengthening the EQA program by integrating rechecking with onsite evaluation is recommended.K

494 DISCOMFORT IN PEOPLE WITH DEMENTIA ADMITTED TO AN ACUTE GENERAL MEDICAL HOSPITAL: A HOSPITAL CROSS SECTIONAL STUDY OF PREVALENCE

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii1-ii4
Author(s):  
R Low ◽  
E West ◽  
P L Sampson
Keyword(s):  
Cross Sectional Study ◽  
Acute Hospital ◽  
Neuropsychiatric Inventory ◽  
Ward Staff ◽  
Cross Sectional ◽  
People With Dementia ◽  
Acute Hospitals ◽  
Severity Of Dementia ◽  
Person With Dementia ◽  
Challenging Behaviours

Abstract Introduction The acute hospital is a challenging place for a person with dementia whose ability to communicate discomfort and need is impaired. Their discomfort may go unnoticed due to insufficient staffing and time resources in this acute environment. Concerns have been raised about the consequences of these overlooked discomfort (e.g. distress and agitation), and hence how we can correctly identify their sources and severity. This study aimed to describe the source of discomfort and challenging behaviours in people with dementia (PwD) in UK acute hospital. Method A cross-sectional observational study of 49 patients with dementia admitted to a NHS acute hospital. Their discomfort was detected and its sources were identified (Sources of Discomfort Scale) during an hour observation when they were at rest and moved by staff. Their challenging behaviours were also recorded (Neuropsychiatric Inventory) through interviewing with the ward staff, as well as documentation of severity of dementia and presence of delirium. Results The overall prevalence of discomfort was 98%, with excessively sleepy or tired being the commonest; 39 (80%) participants experienced three or more type of discomfort. The commonest sources of discomfort were physical (e.g. constipation) and environmental (e.g. physically restrained), affecting up to 43 (88%) and 42 (83%) participants respectively. There was also evidence of an association between delirium and sleepiness or tiredness’s discomfort, meaning that PwD with delirium were nearly triply as likely to feel uncomfortable because of sleepiness or tiredness. Challenging behaviours affected over 80% of our participants, with agitation or aggression being the commonest. On average, these behaviours were moderately severe. Conclusion Discomfort and challenging behaviours were very common in PwD admitted to acute hospitals. Patients and staff would benefit from more accurate and frequent detection of discomfort by focusing on non-pain-related discomfort and using observational scales.

scholarly journals Consultation-Liaison Psychiatry Services in Ireland: A National Cross-Sectional Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Anne M. Doherty ◽  
Rosie Plunkett ◽  
Katherine McEvoy ◽  
Eric Kelleher ◽  
Maurice Clancy ◽  
...  
Keyword(s):  
Resource Constraints ◽  
Cross Sectional Study ◽  
Activity Levels ◽  
Liaison Psychiatry ◽  
Cross Sectional ◽  
Electronic Survey ◽  
Staffing Levels ◽  
Acute Hospitals ◽  
Consultation Liaison Psychiatry ◽  
Minimum Criteria

Objective: This study aimed to describe the provision of consultation-liaison psychiatry (CLP, also known as liaison psychiatry) services in acute hospitals in Ireland, and to measure it against recommended resourcing levels.Methods: This is a survey of all acute hospitals in Ireland with Emergency Departments, via an electronic survey sent by email and followed up by telephone calls for missing data. Data were collected on service configuration, activity, and resourcing. Data were collected from CLP or proxy services at all acute hospitals with an Emergency Department in Ireland (n = 29). This study measured staffing and activity levels where available.Results: None of the services met the minimum criteria set out by either national or international guidance per 500 bed general hospital.Conclusions: CLP is a relatively new specialty in Ireland, but there are clear international guidelines about the staffing levels required to run these services safely and effectively. In Ireland, despite clear national guidance on staffing levels, no services are staffed to the levels suggested as the minimum. It is likely that patients in Ireland's acute hospitals have worse outcomes, and hospitals have unnecessary costs, due to this lack. This is the first study of CLP provision in Ireland and demonstrates the resource constraints under which most services work and the heterogeneity of services nationally.

scholarly journals Performance on bedside tests of attention and organized thinking in patients with dementia free from delirium

2018 ◽  
Vol 31 (1) ◽  
pp. 73-81 ◽  
Author(s):  
Letty Oudewortel ◽  
Karlijn J. Joling ◽  
Cees M. P. M. Hertogh ◽  
Viona J. M. Wijnen ◽  
Anne A. M. van der Brug ◽  
...  
Keyword(s):  
False Positive ◽  
Wide Spectrum ◽  
False Positive Rate ◽  
Cross Sectional Study ◽  
Cognitive Disorder ◽  
Test Results ◽  
Severe Dementia ◽  
Cross Sectional ◽  
Dsm Iv ◽  
Bedside Tests

ABSTRACTObjectives:Bedside tests of attention and organized thinking were performed in patients with cognitive impairment or dementia but without delirium, to provide estimates of false positive rates for detecting delirium superimposed on dementia (DSD).Design and Setting:This cross-sectional study was conducted in outpatients and institutionalized patients without delirium representing a wide spectrum of severity of cognitive impairments.Participants:Patients with dementia or a cognitive disorder according to DSM IV criteria, after exclusion of (suspected) delirium according to DSM IV criteria.Measurements:Tests for inattention and disorganized thinking from the CAM-ICU were assessed.Results:The sample included 163 patients (mean age 83 years (SD 6; 64% women)), with Alzheimer's disease as most prevalent (45%) diagnosis and a mean MMSE-score of 16.8 (SD 7.5). False positive rates of the test of attention varied from 0.04 in patients with normal to borderline cognitive function to 0.8 in those with severe dementia. The false positive rate of the test of disorganized thinking was zero in the normal to borderline group, increasing to 0.67 in patients with severe dementia. When combining test results false positive rates decreased to 0.03 in patients with MMSE scores above 9.Conclusion:Use of simple bedside tests of attention and organized thinking for the clinical diagnosis of DSD will result in high rates of false positive observations if used regardless of the severity of dementia. However, if test results are combined they may be useful to exclude DSD in patients with minimal to moderate degrees of dementia, but not in the severe group.

scholarly journals Factors Affecting the Validity of Coverage Survey Reports of Receipt of Vitamin A Supplements During Child Health Days in Southwestern Burkina Faso

2016 ◽  
Vol 37 (4) ◽  
pp. 529-543 ◽  
Author(s):  
Césaire T. Ouédraogo ◽  
Elodie Becquey ◽  
Shelby E. Wilson ◽  
Lea Prince ◽  
Amadou Ouédraogo ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Vitamin A ◽  
False Positive ◽  
Oral Polio Vaccine ◽  
Cross Sectional Study ◽  
High Dose ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Factors Affecting ◽  
The Past

Background: Assessment of high-dose vitamin A supplementation (VAS) coverage often relies on postevent coverage (PEC) surveys, but the validity of these methods has rarely been evaluated. Objectives: To assess reported VAS coverage and factors associated with missed coverage and to investigate the reliability of the results. Methods: During a cross-sectional survey, 10 454 caregivers of children <27 months old were asked whether their child had received VAS in the past 6 months. During a 48-week longitudinal study of 6232 children 6 to 30 months old, caregivers were asked every 4 weeks if their child had received VAS in the past 4 weeks. Results: The cross-sectional study showed that 94.4% (95% confidence interval [CI]: 93.8%, 94.9%) of eligible children 6 to 26 months of age reportedly received VAS in the previous 6 months, as did 85.8% (CI: 84.5%, 87.2%) of ineligible, 0 to 5 months old children. The longitudinal study showed that 81.6% of children surveyed within 4 weeks following a VAS campaign reportedly received VAS during the campaign and 13.4% of caregivers incorrectly reported receiving VAS when no campaign had actually occurred. False-positive reporting was more likely when oral polio vaccine (OPV) was distributed during the reporting period (20.6% vs 5.4%; P < .001). Showing a photo of OPV during the interview reduced the odds ratio (OR) of false-positive reports (OR = 0.7 [0.6-0.8]). Conclusions: The PEC surveys should include children outside the target age to assess targeting efficiency, and pictures of both VAS and oral vaccines distributed during the same period should be shown during interviews to enhance reporting accuracy.

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