Association between Interleukin-6 Levels and Perioperative Fatigue in Gastric Adenocarcinoma Patients

Background: Gastric adenocarcinoma (GA), one of the most common gastrointestinal cancers worldwide, is often accompanied by cancer cachexia in the advanced stage owing to malnutrition and cancer-related symptoms. Although resection is the most effective curative procedure for GA patients, it may cause perioperative fatigue, worsening the extent of cancer cachexia. Although the relationship between cytokines and cancer fatigue has been evaluated, it is unclear which cytokines are associated with fatigue in GA patients. Therefore, this study aimed to investigate whether the changes in cytokine levels were associated with the perioperative changes in fatigue amongst GA patients. Methods: We included GA patients undergoing gastric surgery in a single academic medical center between June 2017 and December 2018. Fatigue-related questionnaires, serum cytokine levels (interferon-gamma, interleukin (IL)-1, IL-2, IL-5, IL-6, IL-12 p70, tumor necrosis factor-alpha, and granulocyte-macrophage colony-stimulating factor), and biochemistry profiles (albumin, prealbumin, C-reactive protein, and white blood cell counts) were assessed at three time points (preoperative day 0 (POD 0), post-operative day 1 (POD 1), and postoperative day 7 (POD 7)). We used the Brief Fatigue Inventory-Taiwan Form to assess the extent of fatigue. The change in fatigue scores among the three time points, as an independent variable, was adjusted for clinicopathologic characteristics, malnutrition risk, and cancer stages. Results: A total of 34 patients were included for analysis, including 12 female and 22 male patients. The mean age was 68.9 years. The mean score for fatigue on POD 0, POD 1, and POD 7 was 1.7, 6.2, and 3.6, respectively, with significant differences among the three time points (P < 0.001). Among the cytokines, only IL-6 was significantly elevated from POD 0 to POD 1. In the regression model, the change in IL-6 levels between POD 0 and POD 1 (coefficients = 0.01 for every 1 pg/mL increment; 95% confidence interval: 0.01–0.02; P = 0.037) and high malnutrition risk (coefficients = 2.80; 95% confidence interval: 1.45–3.52; P = 0.041) were significantly associated with changes in fatigue scores. Conclusions: The perioperative changes in plasma IL-6 levels are positively associated with changes in the fatigue scores of GA patients undergoing gastric surgery. Targeting the IL-6 signaling cascade or new fatigue-targeting medications may attenuate perioperative fatigue, and further clinical studies should be designed to validate this hypothesis.

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The Impact of Upper Airway Stimulation on Swallowing Function

Ear Nose & Throat Journal ◽

10.1177/0145561319853519 ◽

2019 ◽

Vol 98 (8) ◽

pp. 496-499 ◽

Cited By ~ 1

Author(s):

Colin Huntley ◽

Adam Vasconcellos ◽

Michael Mullen ◽

David W. Chou ◽

Haley Geosits ◽

...

Keyword(s):

Assessment Tool ◽

Medical Center ◽

Academic Medical Center ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Swallowing Function ◽

Upper Airway Stimulation ◽

Obstructive Sleep ◽

The Mean ◽

The Impact

Objective: To evaluate the impact of upper airway stimulation therapy (UAS) on swallowing function in patients with obstructive sleep apnea. Study Design: Prospective cohort study. Setting: Academic medical center. Participants and Outcome Measures: We recorded demographic, preoperative polysomnogram (PSG), operative, and postoperative PSG data. We assessed the patients swallowing function using the Eating Assessment Tool (EAT-10) dysphagia questionnaire. This was administered both pre- and postoperatively. The postoperative EAT-10 survey was administered at least 3 months after UAS implantation. Results: During the study period, 27 patients underwent UAS implantation, completed the pre- and postoperative EAT-10 questionnaire, met inclusion/exclusion criteria, and were included in the study. The cohort consisted of 16 men and 11 women with a mean age of 63.63 years. The mean preoperative BMI, Epworth Sleepiness Scale (ESS), and Apnea Hypopnea Index (AHI) were 29.37, 10.33, and 34.90, respectively. The mean postoperative ESS and AHI were 5.25 and 7.59, respectively. These were both significantly lower than the preoperative values ( P = .026 and P < .001). The mean pre- and postoperative EAT-10 scores were 0.37 and 0.22, respectively ( P = .461). Conclusion: Our data suggest that UAS likely does not lead to postoperative dysphagia.

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A Single Virtual Consult Reduces Severe Hyperglycemia in Patients Admitted with COVID19 Infection

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.683 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A335-A335

Author(s):

Diana Athonvarangkul ◽

Felona Gunawan ◽

Kathryn Nagel ◽

Leigh Bak ◽

Kevan C Herold ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Control Group ◽

Post Intervention ◽

Academic Medical ◽

Treatment Plans ◽

The Mean ◽

Glucose Management ◽

And Control ◽

Glycemic Management

Abstract Diabetes and hyperglycemia are risk factors for morbidity and mortality in hospitalized patients with COVID19. Subspecialty consultative resources to help front-line clinicians treat these conditions is often limited. We implemented a “Virtual Hyperglycemia Surveillance Service (VHSS)” to guide glucose management in COVID19 patients admitted to our 1541-bed academic medical center. From April 22 to June 9, 2020, hospitalized adult patients with COVID19 and 2 or more blood glucose (BG) values greater than 250 mg/dl over 24-h were identified using a daily BG report. The VHSS reviewed BGs and treatment plans, then made recommendations for future glycemic management via a one-time note, visible to all providers. Some patients with re-admission or persistently elevated BG after 1 week received a second VHSS note. We compared BGs from 24-h pre- and 72-h post-intervention starting at 6AM on the day following VHSS review. We also evaluated for hypoglycemia, insulin infusion use and use of formal diabetes consults. A subgroup analysis was performed on patients in the intensive care unit (ICU). At the end of the intervention, we identified a retrospective control cohort admitted to the same hospital from March 21 to April 21, 2020 who met the inclusion criteria for a VHSS assessment. The VHSS group consisted of 100 patients with 126 individual VHSS encounters, and the control group comprised 50 patients. Baseline characteristics in the VHSS and control groups, respectively, were: mean age 62.5 vs 62.1 years, % male 58 vs 56, mean weight 91.4 vs 93.4 kg, BMI 31.8 vs 33.0 kg/m2, and HbA1c 9.1 vs 8.8 %. There were fewer patients in the ICU in the VHSS than control group (44% vs 66%). In the VHSS group, mean BG pre- vs. post-intervention was 260.3 ±21.7 and 227.4 ±25.3 mg/dl (p<0.001). In the control group, mean BG pre-and post- the day they met assessment criteria was 264.8 ± 6.5 mg/dl and 250.6 ± 8.6 mg/dl (p=0.18). There was no difference in the use of insulin infusions or diabetes consults between the two groups. More hypoglycemia (BG<70 mg/dl) occurred in the VHSS than control group (8.3% vs 0%, p=0.04). Within the VHSS group, the average change in BG was significantly greater in ICU than non-ICU patients (-51.8 ±8.7 vs -19.6 ±5.0 mg/dl, p<0.01) and the reduction in the % of BG over 250 mg/dl was also significantly greater in the ICU (-32.2% vs -16.8%, p=0.02). Implementation of a single virtual consult for severely hyperglycemic hospitalized COVID19 patients was associated with rapidly reduced BG concentrations, especially in the ICU. The mean reduction in BG with VHSS intervention was more than 2-fold greater than that observed in our control group. Glucose control remained suboptimal, however, suggesting the need for subsequent input from this specialty service.

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Demographic Factors Associated with Insertional and Noninsertional Achilles Tendinopathy

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00275 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0027

Author(s):

Matt Levitsky ◽

Justin Greisberg ◽

J Turner Vosseller ◽

Shirin Dey ◽

Briana Hickey

Keyword(s):

Physical Examination ◽

Medical Center ◽

Academic Medical Center ◽

Patient Characteristics ◽

Antibiotic Use ◽

Achilles Tendinopathy ◽

Insertional Tendinopathy ◽

Chi Squared ◽

The Mean ◽

Student’S T

Category: Sports Introduction/Purpose: Achilles tendinopathy is a common clinical entity encountered by orthopaedic surgeons, although the demographics of patients that suffer from this pathology are incompletely understood. It has been suggested that there may be differences in patients that get insertional (IAT) and noninsertional Achilles tendinopathy (NIAT), and our clinical experience has been that older, less active patients tend to get insertional tendinopathy. The goal of this study is to further investigate the features of patients in a single institution who presented with Achilles tendinopathy. Methods: We used ICD-9 and ICD-10 codes to find patients who presented with Achilles tendinopathy to two foot and ankle surgeons at one academic medical center from 2007-2018. We made note of patient characteristics such as age, gender, BMI, medical comorbidities, and level of activity. Physical examination, including the presence of a gastrocnemius equinus, was noted as well. Characteristics of insertional and non-insertional tendinopathy subgroups were compared using Student’s T-tests and chi- squared tests. Results: The characteristics of 948 consecutive patients were analyzed. The mean age was 55 years and 50.5% of the patients were male. Patients with IAT had significantly higher BMIs than did those with NIAT (30.5 compared to 28.0, p < .05). The mean age was 54.5 years in the IAT group compared to 55.8 years in the NIAT group (p>.05). Patients with NIAT self-identified as active a greater percentage of the time (63% vs 45%, p<0.5). 76% of the IAT group had a gastrocnemius equinus on physical examination, compared to 67% of the non-insertional group. Antecedent fluoroquinolone antibiotic use was only reported in 10% of patients, and all of these patients presented with NIAT. Conclusion: The age at which patients present with insertional and noninsertional Achilles tendinopathy is not significantly different, although patients with NIAT had a lower BMI and self-identified as active a greater percentage of the time. A gastrocnemius equinus was present in a high percentage of patients with both IAT and NIAT. Fluoroquinolone use was not involved in most cases, although, when it was, patients presented with NIAT.

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Predictors for Severe COVID-19 Infection

Clinical Infectious Diseases ◽

10.1093/cid/ciaa674 ◽

2020 ◽

Vol 71 (8) ◽

pp. 1962-1968 ◽

Cited By ~ 26

Author(s):

Ashish Bhargava ◽

Elisa Akagi Fukushima ◽

Miriam Levine ◽

Wei Zhao ◽

Farah Tanveer ◽

...

Keyword(s):

Risk Factors ◽

Renal Disease ◽

Medical Center ◽

Severe Disease ◽

Academic Medical Center ◽

Severe Infection ◽

Supplemental Oxygen ◽

Multivariable Logistic Regression Analysis ◽

Cell Counts ◽

Novel Coronavirus

Abstract Background COVID-19 is a pandemic disease caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Predictors for severe COVID-19 infection have not been well defined. Determination of risk factors for severe infection would enable identifying patients who may benefit from aggressive supportive care and early intervention. Methods We conducted a retrospective observational study of 197 patients with confirmed COVID-19 admitted to a tertiary academic medical center. Results Of 197 hospitalized patients, the mean (SD) age of the cohort was 60.6 (16.2) years, 103 (52.3%) were male, and 156 (82.1%) were black. Severe COVID-19 infection was noted in 74 (37.6%) patients, requiring intubation. Patients aged above 60 were significantly more likely to have severe infection. Patients with severe infection were significantly more likely to have diabetes, renal disease, and chronic pulmonary disease and had significantly higher white blood cell counts, lower lymphocyte counts, and increased C-reactive protein (CRP) than patients with nonsevere infection. In multivariable logistic regression analysis, risk factors for severe infection included pre-existing renal disease (odds ratio [OR], 7.4; 95% CI, 2.5–22.0), oxygen requirement at hospitalization (OR, 2.9; 95% CI, 1.3–6.7), acute renal injury (OR, 2.7; 95% CI, 1.3–5.6), and CRP on admission (OR, 1.006; 95% CI, 1.001–1.01). Race, age, and socioeconomic status were not independent predictors. Conclusions Acute or pre-existing renal disease, supplemental oxygen upon hospitalization, and admission CRP were independent predictors for the development of severe COVID-19. Every 1-unit increase in CRP increased the risk of severe disease by 0.06%.

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Blood transfusions at end of life for stem cell transplant patients.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.115 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 115-115

Author(s):

Winnie S Wang ◽

Joseph D. Ma ◽

Sandahl H Nelson ◽

Carolyn Revta ◽

Gary T Buckholz ◽

...

Keyword(s):

Stem Cell ◽

Blood Transfusion ◽

End Of Life ◽

Stem Cell Transplant ◽

Medical Center ◽

Academic Medical Center ◽

Primary Objective ◽

Cell Transplant ◽

Hospice Patients ◽

The Mean

115 Background: Transfusions are an essential palliative tool in the stem cell transplant (SCT) population. Limited data exist regarding transfusion practices at end-of-life for SCT patients and whether these practices may limit enrollment in hospice. Methods: A retrospective chart review was conducted of deceased patients with hematologic malignancies who underwent SCT at an academic medical center from 2011 to 2015. The primary objective was to determine the difference between the dates of last transfusion and death in patients enrolled and not enrolled in hospice. A secondary objective was evaluation of the number of transfusions between groups. Data were compiled from a single electronic medical record. Descriptive analyses were performed. Days to last transfusion were analyzed using the Wilcoxon-Mann-Whitney test. Number of packed red blood cell (PRBC) transfusions and platelets transfusions on the last day were analyzed using Fisher and chi-squared tests, respectively. Results: A total of 633 SCT were performed from 2011 to 2015 including 39% (n = 245) allogeneic and 61% (n = 388) autologous transplants (n = 29 patients had 2 transplants). Mean ± SD age of SCT patients was 55 ± 13 years. As of January 2016, 20% (n = 119) of these SCT patients have died. Of those that died, 15% (n = 18) were enrolled in hospice. For SCT patients enrolled in hospice, the mean ± SD time of last blood transfusion from death was 42.3 ± 63.4 days, with mean ± SD 0.67 ± 0.77 units of PRBC’s and 0.72 ± 0.75 units of platelets administered. For SCT patients not enrolled in hospice, the mean ± SD time of last blood transfusion from death was 14.2 ± 47.9 days, with mean±SD total 0.69 ± 1.03 units of PRBC’s and 1.14 ± 1 units of platelets administered. Hospice patients had a statistically significant longer number of days until last blood transfusion compared to non-hospice patients (p < 0.001). There was no difference between SCT patients enrolled in hospice and not enrolled in PRBC transfusions (p = 0.069), but there was a significantly higher amount of platelet transfusions in patients not enrolled in hospice (p < 0.005). Conclusions: This data suggests that time to last transfusion may be a significant obstacle for SCT patients when enrolling in hospice, but requires further validation.

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Abstract 149: Echocardiographic Reporting and Subsequent Referral to a Pulmonary Hypertension Clinic

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.149 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Bruce W Andrus ◽

Malachy J Sullivan ◽

Randolph E Brown ◽

Terrence D Welch ◽

Timothy A Beaver ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Comprehensive Evaluation ◽

Systolic Function ◽

Medical Center ◽

Academic Medical Center ◽

Systolic Pressure ◽

Preliminary Finding ◽

Right Atrial ◽

The Mean ◽

Future Evaluation

Introduction: Pulmonary hypertension (PH) is a common and often ominous finding in the echocardiographic evaluation of patients with cardiopulmonary complaints. As with all diagnostic imaging, the report summary may influence future evaluation. Our aim was to explore the relationship between the echocardiographic reports of patients with PH and subsequent referral to a PH clinic. Methods: From the institutional database of a single academic medical center, we randomly selected 500 reports of patients with an estimated RVSP > 40 mm Hg between 2006 and 2014. Demographic and echocardiographic data were recorded prospectively. Referral to the only PH clinic in the region was determined by searching the electronic medical record. We used multivariable logistic regression to identify demographic and echocardiographic characteristics associated with referral. Results: The mean age of the population was 74 years and 54% (269 of 500) were women. The mean RVSP was 53 mm Hg. Pulmonary hypertension was mentioned in only 31% (153 of 500) of the report summaries and only 4.6% (23 of 500) of all patients were referred to the PH clinic. Referral was associated with younger age, indication for the echo, right atrial and right ventricular (RV) pressure, RV dilatation, and mention of PH in the summary. Mention of PH in the summary was the variable most strongly associated with referral (adjusted OR 4.6, 95% CI 1.5-14.2). Over the time period studied, there was no trend in the frequency of mentioning PH in the summary. The sonographer’s coding of PH as a preliminary finding was strongly associated with physician mention of PH in the summary, persisting after adjustment for RV systolic pressure, RV dilatation, and RV systolic function (adjusted OR 11.3, 95% CI 6.2-20.3). Conclusion: In this single institution study, PH was infrequently mentioned in the echo report summary of patients with an RVSP exceeding 40 mm Hg. Referral to the only PH clinic in the region was relatively rare but occurred more often following mention of PH in the summary. Explicitly stating the presence of pulmonary hypertension in the summary of patients with elevated RSVP may facilitate referral for comprehensive evaluation.

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Limiting the Emergence of Extended-Spectrumβ–Lactamase-Producing Enterobacteriaceae: Influence of Patient Population Characteristics on the Response to Antimicrobial Formulary Interventions

Infection Control and Hospital Epidemiology ◽

10.1086/503016 ◽

2006 ◽

Vol 27 (3) ◽

pp. 279-286 ◽

Cited By ~ 36

Author(s):

Adam D. Lipworth ◽

Emily P. Hyle ◽

Neil O. Fishman ◽

Irving Nachamkin ◽

Warren B. Bilker ◽

...

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Medical Center ◽

Academic Medical Center ◽

Care Facility ◽

Decubitus Ulcer ◽

Population Characteristics ◽

Term Care ◽

Long Term Care Facility

Background.Effective methods to control the emergence of extended-spectrumβ-lactamase-producingEscherichia coliandKlebsiellaspecies (ESBL-EK) remain unclear. Variations in the patient populations at different hospitals may influence the effect of antimicrobial formulary interventions.Methods.To examine variations across hospitals in the response to antimicrobial interventions (ie, restriction of ceftazidime and ceftriaxone) designed to curb the spread of ESBL-EK, we conducted a 5-year quasi-experimental study. This study was conducted at 2 hospitals within the same health system: Hospital A is a 625-bed academic medical center, and Hospital B is a 344-bed urban community hospital. All adult patients with a healthcare-acquired clinical culture of ESBL-EK from July 1, 1997 through December 31, 2002 were included.Results.After the interventions, the use of ceftriaxone decreased by 86% at Hospital A and by 95% at Hospital B, whereas the use of ceftazidime decreased by 95% at Hospital A and by 97% at Hospital B. The prevalence of ESBL-EK at Hospital A decreased by 45% (P< .001), compared with a 22% decrease at Hospital B (P= .36). The following variables were significantly more common among ESBL-EK-infected patients at Hospital B: residence in a long-term care facility (adjusted odds ratio, 3.77 [95% confidence interval, 1.70-8.37]), advanced age (adjusted odds ratio, 1.04 [95% confidence interval, 1.01-1.06]), and presence of a decubitus ulcer (adjusted odds ratio, 4.13 [95% confidence interval, 1.97-8.65]).Conclusions.The effect of antimicrobial formulary interventions intended to curb emergence of ESBL-EK may differ substantially across institutions, perhaps as a result of differences in patient populations. Variability in the epidemiological profiles of ESBL-EK isolates at different hospitals must be considered when designing interventions to respond to these pathogens.

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Cytokine levels in pleural fluid as markers of acute rejection after lung transplantation

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132014000400011 ◽

2014 ◽

Vol 40 (4) ◽

pp. 425-428

Author(s):

Priscila Cilene León Bueno de Camargo ◽

José Eduardo Afonso Jr ◽

Marcos Naoyuki Samano ◽

Milena Marques Pagliarelli Acencio ◽

Leila Antonangelo ◽

...

Keyword(s):

Pleural Fluid ◽

Lung Transplant ◽

Transplant Recipients ◽

Time Points ◽

Cell Counts ◽

Acute Graft Rejection ◽

Cytokine Levels ◽

Differential Cell ◽

Lung Transplant Recipients ◽

Acute Graft

Our objective was to determine the levels of lactate dehydrogenase, IL-6, IL-8, and VEGF, as well as the total and differential cell counts, in the pleural fluid of lung transplant recipients, correlating those levels with the occurrence and severity of rejection. We analyzed pleural fluid samples collected from 18 patients at various time points (up to postoperative day 4). The levels of IL-6, IL-8, and VEGF tended to elevate in parallel with increases in the severity of rejection. Our results suggest that these levels are markers of acute graft rejection in lung transplant recipients.

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Efficacy of Intrathecally Administered Dexmedetomidine Versus Dexmedetomidine With Fentanyl in Patients Undergoing Major Abdominal Cancer Surgery

January 2018 - Pain Physician ◽

10.36076/ppj.2012/15/339 ◽

2012 ◽

Vol 4;15 (4;8) ◽

pp. 339-348 ◽

Cited By ~ 3

Author(s):

Sahar A. Mohamed

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Analgesic Efficacy ◽

Study Groups ◽

Cancer Surgery ◽

Control Group ◽

Double Blind ◽

Scale Scores ◽

The Mean ◽

Sparing Effect

Background: Most of the clinical experience gained in the use of intrathecal α2- adrenoceptor agonists has been described with clonidine. Human studies using a combination of intrathecal dexmedetomidine and local anesthetics are lacking. Objectives: A safety investigation and comparison of the analgesic efficacy of intrathecally administered dexmedetomidine or dexmedetomidine combined with fentanyl in patients undergoing major abdominal cancer surgery. Study Design: A randomized, double-blind trial. Setting: Academic medical center. Methods: Ninety patients were randomly assigned to receive intrathecally either 10 mg bupivacaine 0.5% (control group, n = 30), or 10 mg bupivacaine 0.5% plus 5 µg dexmedetomidine (dexmedetomidine group, n = 30), or 10 mg bupivacaine 0.5% plus 5 µg dexmedetomidine and 25µg fentanyl (dexmedetomidine+ group, n = 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 24 hours. Results: The mean intraoperative heart rate was significantly reduced in the dexmedetomidine group (P < 0.05) and the dexmedetomidine+ group (P < 0.05) compared with the control group. Also, there was a significant reduction in mean intraoperative systolic and diastolic blood pressure in the dexmedetomidine group (P < 0.05) and the dexmedetomidine+ group (P < 0.05) compared with the control group, with no significant differences in postoperative hemodynamics or sedation scores among all the study groups. The mean visual analog scale scores showed a significant reduction immediately and at 12 hours postoperatively in both the dexmedetomidine and dexmedetomidine+ groups compared to the control group. The mean time of the first analgesic request was significantly prolonged in the dexmedetomidine group (3.30 ± 0.87 hours, P < 0.01) and the dexmedetomidine+ group (5.41 ± 1.23 hours, P < 0.01) compared with the control group (0.23 ± 0.11 hours). Moreover, postoperative tramadol consumption was significantly reduced in the dexmedetomidine (142.85 ± 13.04 mg, P < 0.01) and the dexmedetomidine+ (131.25 ± 11.96 mg, P < 0.01) groups, compared with the control group (310.0 ± 12.08 mg). No significant serious adverse effects were recorded during the study. Limitations: This study is limited by its sample size. Conclusion: Dexmedetomidine 5 µg given intrathecally improves the quality and the duration of postoperative analgesia and also provides an analgesic sparing effect in patients undergoing major abdominal cancer surgery. Furthermore, the addition of intrathecal fentanyl 25 µg has no valuable clinical effect. Key words: dexmedetomidine, fentanyl, intrathecal, postoperative pain

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Risk of ionizing radiation exposure from CT scans in the Neuro ICU - a patient safety blind spot?

F1000Research ◽

10.12688/f1000research.9680.1 ◽

2016 ◽

Vol 5 ◽

pp. 2489

Author(s):

Avinash B. Kumar ◽

Roy C. Neeley

Keyword(s):

Mechanical Ventilation ◽

Patient Safety ◽

Ionizing Radiation ◽

Radiation Exposure ◽

Medical Center ◽

Academic Medical Center ◽

Ct Scans ◽

Academic Medical ◽

The Mean ◽

Ct Studies

Introduction: The exposure to ionizing radiation has increased significantly with the wide availability of computed tomography (CT) scans and portable imaging technology. We examine the pattern of use of inpatient diagnostic imaging and radiation exposure in the neuro-intensive care unit (Neuro ICU, N-ICU) patient population at a large academic medical center. Methods: We retrospectively evaluated all patients admitted to the Neuro ICU at our academic medical center from January 1 to December 31, 2013. The number and type of CT studies was collected, and the corresponding estimated radiation dose was calculated. We limited the evaluation to CT scans, which accounts for the majority of radiation exposure. Data were electronically collected and cross-referenced to the patients’ electronic medical records (EMR) and radiology records. Radiation dose estimates were calculated based on published reference values and conversion factors (CT head (2mSv)), CT angiography of the head and neck (7-10 mSv), Ct Chest /Abd/pelvis ( 10 mSv), CT cerebral perfusion analysis (3.3 mSv). Results: In the calendar year 2013, we had a total of 2353 admission encounters (F=1078). The mean age on admission was 56.55Y ± 16.7. The mean length of ICU stay was 6.3 days. Mechanical ventilation was initiated on 420 patients with a mean length on mechanical ventilation 5.09 days. 2028 CT scans were completed of which approximately 60% were head CT without contrast (n=1209). 379 patients had multiple CT studies. The mean number of studies was 3.8 ± 2. The number of patients with more thanthree3 studies during their ICU stay was 159. The maximum number of studies on a single patient was 21. Conclusion: Patients in the Neuro ICU are at a risk for significant exposure to ionizing radiation. Radiation exposure must be factored into the culture of quality and patient safety in the ICU.

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