Diagnostic Yield of Pediatric Colonoscopies Based on Presenting Symptoms in a Secondary Hospital

2011 ◽  
Vol 14 (4) ◽  
pp. 368
Author(s):  
Yun Jung Cho ◽  
Il Hyun Cho ◽  
Hyo Joo Yoo ◽  
Hwang Choi ◽  
Bo-In Lee ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Presenting Symptoms ◽  
Secondary Hospital

scholarly journals Diagnostic Yield of MRI for Sensorineural Hearing Loss – An Audit

2020 ◽  
Vol 47 (5) ◽  
pp. 656-660
Author(s):  
Helen Wong ◽  
Yaw Amoako-Tuffour ◽  
Khunsa Faiz ◽  
Jai Jai Shiva Shankar
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Diagnostic Yield ◽  
Internal Auditory Canal ◽  
Auditory Brainstem ◽  
Sensorineural Hearing ◽  
Vestibular Evoked Myogenic Potentials ◽  
Clinical Indication ◽  
Presenting Symptoms ◽  
Brainstem Response

ABSTRACT:Purpose:Contrast-enhanced magnetic resonance imaging (CEMRI) of the head is frequently employed in investigations of sensorineural hearing loss (SNHL). The yield of these studies is perceptibly low and seemingly at odds with the aims of wise resource allocation and risk reduction within the Canadian healthcare system. The purpose of our study was to audit the use and diagnostic yield of CEMRI for the clinical indication of SNHL in our institution and to identify characteristics that may be leveraged to improve yield and optimize resource utilization.Materials and methods:The charts of 500 consecutive patients who underwent CEMRI of internal auditory canal for SNHL were categorized as cases with relevant positive findings on CEMRI and those without relevant findings. Demographics, presenting symptoms, interventions and responses, ordering physicians, and investigations performed prior to CEMRI testing were recorded. Chi-squared test and t-test were used to compare proportions and means, respectively.Results:CEMRI studies revealed relevant findings in 20 (6.2%) of 324 subjects meeting the inclusion criteria. Pre-CEMRI testing beyond audiometry was conducted in 35% of those with relevant positive findings compared to 7.3% of those without (p < 0.001). Auditory brainstem response/vestibular-evoked myogenic potentials were abnormal in 35% of those with relevant CEMRI findings compared to 6.3% of those without (p < 0.001).Conclusion:CEMRI is a valuable tool for assessing potential causes of SNHL, but small diagnostic yield at present needs justification for contrast injection for this indication. Our findings suggest preferred referral from otolaryngologists exclusively, and implementation of a non-contrast MRI for SNHL may be a better diagnostic tool.

P5676Implementing a syncope pathway

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Saurer ◽  
M Mezler-Andelberg ◽  
W Weihs
Keyword(s):  
Diagnostic Yield ◽  
Correct Diagnosis ◽  
Challenge Test ◽  
Initial Evaluation ◽  
Time To Diagnosis ◽  
Esc Guidelines ◽  
Secondary Hospital ◽  
Work Up ◽  
Care Costs ◽  
Careful History

Abstract Background Syncope is a common presenting symptom in emergency departments (0.8–2.4%) and is associated with high health care costs. In up to 40% of cases, etiology remains unidentified after initial evaluation. Purpose To assess the increase in diagnostic yield and the time to diagnosis by implementing a structured pathway in syncope evaluation according ESC- Guidelines in a secondary hospital. Methods In the study, we compared 2 groups of patients with T-LOC. We evaluated the diagnostic yield and the time to diagnosis. The first group comprised all patients with T-LOC referred to the emergency department (ED) of the hospital from January to March 2016. The work-up was done according to existing clinical practice. After implementation of a structured pathway in syncope evaluation according to ESC-Guidelines, we reevaluated the diagnostic yield and the time to diagnosis in all patients referred to ED with T-LOC from July to September 2017. The implementation consisted of an initial evaluation (careful history taking with a checklist, physical examination, ECG, orthostatic challenge test carried out by nurses), risk assessment and instructing the medical staff. Results There were 169 vs. 85 patients presenting with suspected T-LOC in the ED. 130 (77%) vs. 65 (76.5%) were classified as having a syncope. The diagnostic yield in the syncope patients was 60% vs. 80% (p=0.013). The rate of correct diagnosis within 14 days increased from 55 to 80%. Conclusion By implementing a structured pathway and educating the staff, we succeeded in increasing diagnostic yield from 60 to 80%. This could be achieved in a reduced referral to diagnosis time.

scholarly journals The Unyvero Hospital-Acquired pneumonia panel for diagnosis of secondary bacterial pneumonia in COVID-19 patients

2020 ◽  
Author(s):  
Chaitanya Tellapragada ◽  
Christian G. Giske
Keyword(s):  
Diagnostic Yield ◽  
Bacterial Species ◽  
Reference Method ◽  
Standard Of Care ◽  
Application Performance ◽  
Predictive Values ◽  
Microbiological Culture ◽  
Hospital Acquired Pneumonia ◽  
Secondary Hospital ◽  
Hospital Acquired

AbstractThe study was undertaken to evaluate the performance of Unyvero Hospitalized Pneumonia Panel (HPN) Application, a multiplex PCR based method for the detection of bacterial pathogens from lower respiratory tract (LRT) samples, obtained from COVID-19 patients with suspected secondary hospital-acquired pneumonia. Residual LRT samples obtained from critically ill COVID-19 patients with predetermined microbiological culture results were tested using the Unyvero HPN Application. Performance evaluation of the HPN Application was carried out using the standard-of-care (SoC) microbiological culture findings as the reference method. Eighty-three LRT samples were used in the evaluation. The HPN Application had a full concordance with SoC findings in 59/83 (71%) samples. The new method detected additional bacterial species in 21 (25%) and failed at detecting a bacterial species present in lower respiratory culture in 3 (3.6%) samples. Overall the sensitivity, specificity, positive and negative predictive values of the HPN Application were 95.1% (95%CI: 96.5-98.3%); 98.3% (95% CI: 97.5-98.9%); 71.6% (95% CI: 61.0-80.3%) and 99.8% (95% CI: 99.3-99.9%) respectively. In conclusion, the HPN Application demonstrated higher diagnostic yield in comparison with the culture and generated results within 5 hours.

Abstract 8: Early MRI in TIA And Minor Stroke: Do it or Lose it

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Francois Moreau ◽  
Jayesh Modi ◽  
Mohamed Almekhlafi ◽  
Simer Bal ◽  
Mayank Goyal ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Diagnostic Yield ◽  
Lesion Detection ◽  
White Matter Hyperintensity ◽  
Minor Stroke ◽  
Presenting Symptoms ◽  
Lesion Pattern ◽  
Cortical Stroke ◽  
Stroke Lesion ◽  
The Impact

Background: MRI is not always completed early after TIA or minor stroke and this may affect its utility. We measured the impact of scanning an individual patient late versus early in the investigation of TIA and minor stroke. Methods: 263 patients with a TIA or minor stroke (NIHSS <4) from the CATCH study were included in this analysis. To be included in this sub study patients needed to have had a baseline MRI completed within 24 hours of symptom onset and a follow-up MRI at 90 days. All MRI images were acquired on a 3.0 Tesla GE scanner. Baseline and 90 day scans were assessed independently for the presence of any stroke lesion. The presence and pattern of any stroke lesion was then compared at the two time points. Lesion patterns were classified as: no definite stroke, single territory cortical stroke(s), multiple territory cortical strokes, single territory subcortical only stroke(s), multiple territory subcortical only strokes, and multiple strokes in one territory including a cortical stroke Results: Stroke of any age, in any location was more common on the baseline MRI versus 90day MRI (68% versus 58%, p=0.005). A substantial proportion of the negative scans at 90 days had a clearly identifiable stroke on the baseline scan (35/115: 30%) that was missed on the 90day scan. All of these lesions were acute or subacute DWI lesions on the baseline scan showing non-specific white matter hyperintensity or no abnormality on the 90day scan. Among 104 patients with a stroke lesion on the 90 day MRI considered as a cause for the presenting symptoms, this lesion was the correct lesion in only 78 (53%) patients. 89 (34%) patients had a different lesion pattern on the baseline scan versus the 90day scan. The main difference observed was that patients with multiple DWI lesions on the baseline scan were either seen as a single or no lesions on the 90day MRI. Conclusion: Completing an MRI in a delayed fashion after TIA or minor stroke reduces the diagnostic yield of the imaging. Not only does it reduce lesion detection, but also the pattern of the lesions is missed. Conclusions regarding the original event may be false if based only on a delayed MRI. If minor stroke and TIA patients are going to be scanned with MRI this should be completed early after symptom onset.

scholarly journals The diagnostic yield of CTPA: pulmonary embolism, alternative diagnoses and incidental findings

2016 ◽  
Vol 15 (3) ◽  
pp. 130-133
Author(s):  
Shoaib Faruqi ◽  
◽  
Nalla Kishore ◽  
Richard Bodington ◽  
Salim Meghjee ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Incidental Findings ◽  
Clinical Presentation ◽  
Diagnostic Yield ◽  
Patient Anxiety ◽  
Presenting Symptoms ◽  
Pulmonary Angiogram ◽  
Unexpected Findings ◽  
Made In

Aims: In this retrospective study we assess the diagnostic yield of computed tomography pulmonary angiogram (CTPA) and the incidence of alterative and incidental diagnoses. Methods: The results of all CTPA scans performed in our trust over a period of 18 months were reviewed and all diagnoses noted. Data collected was descriptively analysed. Results: A total of 1138 scans were performed (56.5% men, mean age 59 years). A diagnosis of pulmonary embolism (PE) was made in 20.2%, an alternative aetiology for presenting symptoms in 26.4% and incidental findings in 19.5%. The commonest alternative diagnosis was pneumonia (9.5%). Conclusions: Significant numbers of CTPA yield unexpected findings, which may provide an explanation for the clinical presentation. Furthermore substantial numbers of incidental pathologies are also diagnosed which may lead to inappropriate resource utilization and increased patient anxiety.

scholarly journals The Unyvero Hospital-Acquired pneumonia panel for diagnosis of secondary bacterial pneumonia in COVID-19 patients

2021 ◽  
Author(s):  
Chaitanya Tellapragada ◽  
Christian G. Giske
Keyword(s):  
Diagnostic Yield ◽  
Bacterial Species ◽  
Reference Method ◽  
Standard Of Care ◽  
Application Performance ◽  
Predictive Values ◽  
Microbiological Culture ◽  
Hospital Acquired Pneumonia ◽  
Secondary Hospital ◽  
Hospital Acquired

AbstractThe study was undertaken to evaluate the performance of Unyvero Hospitalized Pneumonia (HPN) panel application, a multiplex PCR-based method for the detection of bacterial pathogens from lower respiratory tract (LRT) samples, obtained from COVID-19 patients with suspected secondary hospital-acquired pneumonia. Residual LRT samples obtained from critically ill COVID-19 patients with predetermined microbiological culture results were tested using the Unyvero HPN Application. Performance evaluation of the HPN Application was carried out using the standard-of-care (SoC) microbiological culture findings as the reference method. Eighty-three LRT samples were used in the evaluation. The HPN Application had a full concordance with SoC findings in 59/83 (71%) samples. The new method detected additional bacterial species in 21 (25%) and failed at detecting a bacterial species present in lower respiratory culture in 3 (3.6%) samples. Overall the sensitivity, specificity, positive, and negative predictive values of the HPN Application were 95.1% (95%CI 96.5–98.3%), 98.3% (95% CI 97.5–98.9%), 71.6% (95% CI 61.0–80.3%), and 99.8% (95% CI 99.3–99.9%), respectively. In conclusion, the HPN Application demonstrated higher diagnostic yield in comparison with the culture and generated results within 5 h.

scholarly journals Role of bronchoscopy in diagnosis of pulmonary infections in non-HIV immune compromised host

2018 ◽  
Vol 5 (1) ◽  
pp. 207
Author(s):  
Palaniappan Chockalingam ◽  
Deepaselvi Meyyappan
Keyword(s):  
Bacterial Infections ◽  
Diagnostic Yield ◽  
Treatment Plan ◽  
Specific Treatment ◽  
Pulmonary Diseases ◽  
Secondary Outcome ◽  
Fungal Culture ◽  
Immunocompromised Patients ◽  
Pulmonary Infections ◽  
Presenting Symptoms

Background: The occurrence of pulmonary infections is a common life threatening complication in immunocompromised patients, necessitating timely diagnosis and specific treatment. In our study bronchoscopic diagnostic techniques that include fiber optic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) were applied in non-HIV immunocompromised conditions to determine the aetiology infectious microorganisms and comparing the clinical characteristics with bronchoscopic yield and to assess the influence of these methods on therapeutic outcome in this population.Methods: This prospective observational study was conducted at Rajiv Gandhi Government General Hospital, Park Town, Chennai, for a period of 8 months from January 2016 – August 2016.After meeting the requirements of eligibility criteria, the study included 65 immunocompromised patients consecutively who presented with pulmonary diseases. The primary outcome measure was the diagnostic yield of bronchoscopy among non-HIV immunocompromised patients. The secondary outcome measures were collecting the data including etiology of different microorganisms and non-infectious causes of pulmonary diseases among non- HIV immunocompromised patients, comparing the symptoms at the time of presentation, different radiological pattern with bronchoscopic yield and comparing the different subgroups of non-HIV immunocompromised patients with regards to presenting symptoms, radiological patterns, bronchoscopic yield, treatment modification, different spectrum of infections and complications.Results: The mean age of the patients was 41.91 ranging from 15-74 years. Majority (n=36) patients showed chest symptoms alone. On bronchoscopy, 52 cases (80%) out of 65 showed positive results and negative result was noticed in 13 cases (20%). Among them bacterial infections were predominant with 24%. After BAL culture bacterial culture was positive in 23 (35%) patients and fungal culture was positive in 15 (23%) cases. After bronchoscopy, current treatment plan was changed in 37 patients and clinical improvement was seen in 26 cases i.e. yield of bronchoscopy was 71%. Minor complications were noticed in 16 cases after bronchoscopy.Conclusion: Our study concludes, in clinically stable patients FOB was the preferred technique for finding the cause of lung infiltrates in non-HIV immunocompromised patients. Because our results signifies that the yield of bronchoscopy was high (80%) despite empirical antimicrobial therapy.

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