Biomedical subjects

M S O'Brien-Irr

Publications and source records attributed to M S O'Brien-Irr.

3 recordsLinked to original sources

PubMed2001

Evaluation of a screening protocol to exclude the diagnosis of deep venous thrombosis among emergency department patients.

OBJECTIVE: The purpose of this study was to evaluate the efficacy and cost effectiveness of a deep venous thrombosis (DVT) screening protocol incorporating DVT pretest probability (PTP), selective D-dimer assay, and venous duplex imaging (VDI) to exclude the diagnosis of DVT among emergency department (ED) patients. METHODS: A prospective study of all patients evaluated in the ED for suspected DVT during 1 year was undertaken. Patients were classified into PTP risk category by ED physicians before VDI. Correlation studies were completed using VDI as the gold standard. Charges associated with the protocol were calculated. RESULTS: One hundred fourteen patients were included. The incidence of DVT was 9.6% (11). Thirty-six (55%) patients were classified as high risk, 23 (35%) as moderate, and 7 (10%) as low risk. All patients diagnosed with DVT were in the high-risk group (incidence, 16.7%). The sensitivity and negative predictive value were both 100% when PTP and D-dimer were used, but fell to 80% and 95%, respectively, when only D-dimer was considered. The true negative rates were 23% and 37%, respectively. Based on this study, we propose the following screening: for high-risk patients, use direct VDI (no D-dimer); for low-risk or moderate-risk patients, obtain D-dimer, and if it is positive, use VDI, and if it is negative, no further action is required. The average charge associated with the protocol was 170.50 dollars as opposed to 202.00 dollars for global VDI. CONCLUSION: A screening protocol using PTP along with selective D-dimer and VDI to exclude the diagnosis of DVT among ED patients is efficacious and cost efficient. This screening approach establishes criteria to satisfy billing requirements, can eliminate unnecessary VDI in 23% of ED referrals, and can reduce charges by 16%.

Adult↗

PubMed1997

Completion angiography, is it really necessary?

BACKGROUND: Routine completion imaging after carotid endarterectomy (CEA) has been advocated by many investigators to detect and repair unsuspected defects with the goal of reducing perioperative morbidity and residual disease. However, completion imaging has been performed rarely in our practice. Our carotid registry was interrogated to determine whether omitting routine completion imaging adversely affected outcome. METHODS: A retrospective review of 229 consecutive CEAs performed by one vascular surgeon during 1988 to 1996 was completed. Duplex follow-up was used to identify persistent residual defects, which were classified as 50% to 74%, 75% to 99%, and occlusion in the common (CCA), internal (ICA), and external (ECA) arteries and was available in 192 cases. RESULTS: During the study period, eight completion angiograms were performed (3.5%) and 5 arteries were reopened. Combined stroke and death rate was 3.1% (7 of 229). Duplex follow-up, available on 192 patients, showed residual lesions in 29 patients (15%), but only 7 (3.6%) involving the internal or common carotid. CONCLUSION: Routine completion imaging is not required to achieve acceptable morbidity and mortality and minimize residual problems after CEA. Attention to operative details with selective imaging will give excellent results.

Angiography↗

PubMed1997

Conservative management of residual and recurrent lesions after carotid endarterectomy: long-term results.

PURPOSE: To document the natural history of residual and recurrent carotid stenoses that are initially treated without surgery, and to identify risk factors for recurrent stenosis. METHODS: Review of data from a prospective carotid database with clinical and duplex follow-up. Analysis of rate of restenosis and rate of late reoperation by life table. Risk factor analysis by chi 2 and LEE-DESU statistics. RESULTS: Three hundred forty-eight patients were available for follow-up, with 12 residual lesions (3.7%) and 22 recurrent lesions (6.6%). Rate of recurrent stenosis by life table analysis was 8.7% and 13% at 3 and 5 years. Restenosis was associated with smoking (p = 0.04) and contralateral progression. Only 21% of patients were underwent an operation within 5 years (p = 0.007) of restenosis developing, but eventually 10 of 22 patients required reoperation at long-term follow-up, eight for symptoms and two for progressive proximal stenoses. The late stroke rate was increased in patients who had residual or recurrent lesions compared with those who had normal duplex study results (18% vs 6%; p = 0.16) and was related to the ipsilateral artery. CONCLUSIONS: Recurrent lesions that remain asymptomatic can be managed without operation with likelihood of success in the near term (5 years). However, these patients are at increased risk of late stroke, and almost half will eventually require operation. Therefore, in good-risk patients operation for asymptomatic restenosis should be considered.

Aged↗