RESUMEN
BACKGROUND: Tranexamic acid (TXA) has been shown to reduce mortality in the treatment of traumatic hemorrhage. This effect seems most profound when given early after injury. We hypothesized that extending a protocol for TXA administration into the prehospital aeromedical setting would improve outcomes while maintaining a similar safety profile to TXA dosed in the emergency department (ED). MATERIALS AND METHODS: We identified all trauma patients who received TXA during prehospital aeromedical transport or in the ED at our urban level I trauma center over an 18-mo period. These patients had been selected prospectively for TXA administration using a protocol that selected adult trauma patients with high-risk mechanism and concern for severe hemorrhage to receive TXA. Patient demographics, vital signs, lab values including thromboelastography, blood administration, mortality, and complications were reviewed retrospectively and analyzed. RESULTS: One hundred sixteen patients were identified (62 prehospital versus 54 ED). Prehospital TXA patients were more likely to have sustained blunt injury (76% prehospital versus 46% ED, P = 0.002). There were no differences between groups in injury severity score or initial vital signs. There were no differences in complication rates or mortality. Patients receiving TXA had higher rates of venous thromboembolic events (8.1% in prehospital and 18.5% in ED) than the overall trauma population (2.1%, P < 0.001). CONCLUSIONS: Prehospital administration of TXA during aeromedical transport did not improve survival compared with ED administration. Treatment with TXA was associated with increased risk of venous thromboembolic events. Prehospital TXA protocols should be refined to identify patients with severe hemorrhagic shock or traumatic brain injury.
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Ambulancias Aéreas/estadística & datos numéricos , Antifibrinolíticos/administración & dosificación , Servicio de Urgencia en Hospital/estadística & datos numéricos , Choque Hemorrágico/terapia , Ácido Tranexámico/administración & dosificación , Tromboembolia Venosa/epidemiología , Adulto , Antifibrinolíticos/efectos adversos , Transfusión Sanguínea/estadística & datos numéricos , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Choque Hemorrágico/etiología , Choque Hemorrágico/mortalidad , Tromboelastografía , Factores de Tiempo , Ácido Tranexámico/efectos adversos , Resultado del Tratamiento , Tromboembolia Venosa/inducido químicamente , Tromboembolia Venosa/diagnóstico , Heridas y Lesiones/complicaciones , Heridas y Lesiones/diagnóstico , Adulto JovenRESUMEN
BACKGROUND: The utilization of spinal cord stimulation (SCS) to treat intractable pain has increased substantially in recent years. Integral to this therapy, the fluoroscope assists with requisite mapping protocols during trialing procedures to identify topographical dermatomal representations of spinal segments, and its use demands measurements of radiation exposure. However, such data is not found in the literature. PURPOSE: The aim of this study was to report on radiation exposure during percutaneous SCS trialing procedures. DESIGN: An observational study. SETTING: A non-university out-patient Interventional Pain Management practice in the United States. METHODS: Fluoroscopy time from 110 SCS trialing procedures performed in a non-university, outpatient setting was studied retrospectively. Summary statistics were reported for all procedures collectively, as well as for lead arrangement and location. The interventional spine team carried out all procedural cases with the same mobile C-arm fluoroscopy system. Incident air kerma was evaluated by simplistic modeling. RESULTS: Mean total fluoroscopy time was 133.4 s with a standard deviation of 84.8 s, and the mean percentage of time allocated to pulsed fluoroscopy was 31.9%. Fluoroscopy time for the most common lead arrangement/location, neural canal dual leads/low-thoracic (n=87), ranged from 28.5 s to 387.4 s. Incident air kerma was 1.8-43.7 mGy. LIMITATIONS: A preliminary report with a sample size of 110. CONCLUSION: Various lead placement options are available to the spinal interventionalist to treat pain with SCS. Our data set provides first steps to obtain benchmark reference estimates on fluoroscopy times and radiation exposure during SCS trialing procedures/spinal segment mapping. Fluoroscopy times for such interventions may be considerable when compared to more commonly performed pain medicine procedures; however, skin injury is improbable.
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Terapia por Estimulación Eléctrica/métodos , Fluoroscopía/efectos adversos , Dolor Intratable/terapia , Cuidados Preoperatorios/efectos adversos , Traumatismos por Radiación/etiología , Médula Espinal/diagnóstico por imagen , Relación Dosis-Respuesta en la Radiación , Electrodos/normas , Femenino , Fluoroscopía/métodos , Humanos , Masculino , Cuidados Preoperatorios/métodos , Dosis de Radiación , Traumatismos por Radiación/fisiopatología , Traumatismos por Radiación/prevención & control , Monitoreo de Radiación/métodos , Estudios Retrospectivos , Médula Espinal/fisiopatología , Médula Espinal/cirugía , Factores de Tiempo , Estimulación Eléctrica Transcutánea del Nervio/métodosRESUMEN
OBJECTIVE: The purpose of this study was to investigate the variability of CT colonography (CTC) scan quality obtained within and between institutions by using previously validated automated quality assessment (QA) software that assesses colonic distention and surface area obscured by residual fluid. MATERIALS AND METHODS: The CTC scans of 120 patients were retrospectively selected, 30 from each of four institutions. The bowel preparation included oral contrast material for fecal and fluid tagging. Patients at one institution (institution 4) drank half the amount of oral contrast material compared with the patients at the other three institutions. Fifteen of the CTC scans were from the beginning of the protocol studied at each institution and 15 scans were from the same protocol acquired approximately 1 year later in the study. We used previously validated QA software to automatically measure the mean distention and residual fluid of each of five colonic segments (ascending, transverse, descending, sigmoid, and rectum). Adequate distention was defined as a colonic diameter of at least 2 cm. Residual fluid was determined by the percentage of colonic surface area covered by fluid. We compared how the quality varied across multiple institutions and over time within the same institution. RESULTS: No significant difference in the amount of colonic distention among the four institutions was found (p = 0.19). However, the distention in the prone position was significantly greater than the distention in the supine position (p < 0.001). Patients at institution 4 had about half the amount of residual colonic fluid compared with patients at the other three institutions (p < 0.01). The sigmoid and descending colons were the least distended segments, and the transverse and descending colons contained the most fluid on the prone and supine scans, respectively. More recently acquired studies had greater distention and less residual fluid, but the differences were not statistically significant (p = 0.30 and p = 0.96, respectively). CONCLUSION: Across institutions, a significant difference can exist in bowel preparation quality for CTC. This study reaffirms the need for standardized bowel preparation and quality monitoring of CTC examinations to reduce poor CTC performance.
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Colonografía Tomográfica Computarizada/métodos , Colonografía Tomográfica Computarizada/normas , Neoplasias Colorrectales/diagnóstico por imagen , Garantía de la Calidad de Atención de Salud , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Estados UnidosRESUMEN
OBJECTIVE: A computer-aided detection (CAD) system with high sensitivity in the detection of adenomatous polyps in varied CT colonography (CTC) data sets increases the utility of CAD in the clinical setting. The purpose of this study was to evaluate the standalone performance of an existing CAD system with a new set of CTC data from screening patients at an institution and geographic location different from those at which the CAD system was trained. MATERIALS AND METHODS: CTC data were collected from the records of 104 patients undergoing screening for colorectal neoplasia. Most of the patients were at average risk, had CTC findings suggestive of polyps, and underwent colonoscopy. Patients underwent cathartic bowel preparation, were given an oral contrast agent, and underwent imaging in the prone and supine positions. The patients had 86 adenomas confirmed at same-day optical colonoscopy; 47 of these tumors were 10 mm in diameter or larger, and 39 measured 6-9 mm. The CTC data were analyzed with an existing CAD system for colonography that was trained with previously acquired data. In a previous non-polyp-enriched screening cohort, the standalone performance of the CAD system was 93.3% (28/30) sensitivity for adenomatous polyps 10 mm or larger, 51.1% (47/92) sensitivity for adenomas 6-9 mm, and a mean false-positive rate of 8.6 per patient. Sensitivity comparisons were made with findings in the previous study. RESULTS: The CAD system had per-polyp sensitivities of 91.5% (43/47; 95% CI, 78.7-97.2%; p = 1.0) for adenomas 10 mm or larger and 82.1% (32/39; 65.9-91.9%; p = 0.0009) for adenomas 6-9 mm. The per-patient sensitivities were 97.6% (40/41; 85.6-99.9%; p = 0.6) for patients with adenomas 10 mm or larger and 82.4% (28/34; 64.8-92.6%; p = 0.047) for patients with adenomas 6-9 mm. The mean and median false-positive rates were 9.6 +/- 9.6 and 7.0 per patient, respectively. Common reasons for CAD misses (false-negative findings) were the presence of adherent contrast medium, flat adenomas, and adenomas located on or adjacent to normal colonic folds. In a random sample, 72.5% (29/40) of false-positive findings were attributable to folds or residual feces. CONCLUSION: The CAD system evaluated has a high level of performance in the detection of adenomatous polyps with CTC data from a polyp-enriched cohort different from that used to train the system.
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Inteligencia Artificial , Pólipos del Colon/diagnóstico por imagen , Colonografía Tomográfica Computarizada/métodos , Neoplasias Colorrectales/diagnóstico por imagen , Reconocimiento de Normas Patrones Automatizadas/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intensificación de Imagen Radiográfica/métodos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: The purpose of this study was to validate automated quality assessment (QA) software for CT colonography (CTC) by comparing results obtained with the software with results of interpretation by radiologists in the assessment of colonic distention and surface area obscured by residual fluid. MATERIALS AND METHODS: CTC scans of 30 patients were selected retrospectively to span ranges of luminal distention (well distended to poorly distended) and surface area covered by residual fluid (high amount of coverage to low amount of coverage). We used QA software developed in our laboratory to automatically measure the mean distention of each of five colonic segments (ascending, transverse, descending, sigmoid, and rectum). Three experienced radiologists visually graded each scan for distention and fluid coverage. Distention and fluid scores for specific segments were assessed with Bland-Altman analysis (mean difference with 95% limits of agreement) and the weighted kappa test. Interobserver and intraobserver variability was determined with the weighted kappa test. RESULTS: For distention scoring, the mean difference between radiologists and the QA software was 0.1% (95% limits of agreement, -25.6% and 25.9%). For fluid scoring, the mean difference was -0.6% (95% limits of agreement, -8.2% and 7.1%). There was moderate to good agreement (weighted kappa value, 0.50-0.78) between the radiologists' mean scores and the scores obtained with the QA software and for interreader and intrareader assessments of distention and fluid coverage. CONCLUSION: Results with the QA software agreed with radiologists' assessment of colonic distention and residual fluid coverage but were a more objective assessment. Use of this QA software can help standardize two important factors, distention and residual fluid coverage, that affect the quality of CTC, reducing two known causes of poor CTC performance.