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Performance of the 2-hour accelerated diagnostic protocol within the American College of Radiology Imaging Network PA 4005 cohort.

ABSTRACT: The 2-hour accelerated diagnostic protocol (ADAPT) is a decision rule designed to identify emergency department (ED) patients with chest pain for early discharge. Previous studies in the Asia-Pacific region demonstrated high sensitivity (97.9% to 99.7%) for major adverse cardiac events (MACE) at 30 days. The objective of this study was to determine the validity of ADAPT for risk stratification in a cohort of U.S. ED patients with suspected acute coronary syndrome (ACS).A secondary analysis of participants enrolled in the American College of Radiology Imaging Network (ACRIN) PA 4005 trial was conducted. This trial enrolled 1,369 patients at least 30 years old with symptoms suggestive of ACS. All data elements were collected prospectively at the time of enrollment. Each patient was classified as low risk or at risk by ADAPT. Early discharge rate and sensitivity for MACE, defined as cardiac death, myocardial infarction (MI), or coronary revascularization at 30 days, were calculated.Of 1,140 patients with complete biomarker data, MACE occurred in 31 patients (2.7%). Among 551 of the 1,140 (48.3%, 95% confidence interval [CI] = 45.4% to 51.3%), ADAPT identified for early discharge; five of the 551 (0.9%, 95% CI = 0.3% to 2.1%) had MACE at 30 days. ADAPT was 83.9% (95% CI = 66.3% to 94.5%) sensitive, identifying 26 of 31 patients with MACE. Of the five patients identified for early discharge by ADAPT with MACE, there were no deaths, one patient with MI, and five with revascularizations.In this first North American application of the ADAPT strategy, sensitivity for MACE within 30 days was 83.9%. One missed adverse event was a MI, with the remainder representing coronary revascularizations. The effect of missing revascularization events needs further investigation.

SUBMITTER: Mahler SA

PROVIDER: S-EPMC4405137 | biostudies-literature | 2015 Apr

REPOSITORIES: biostudies-literature

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Performance of the 2-hour accelerated diagnostic protocol within the American College of Radiology Imaging Network PA 4005 cohort.

Mahler Simon A SA Miller Chadwick D CD Litt Harold I HI Gatsonis Constantine A CA Snyder Bradley S BS Hollander Judd E JE

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 20150324 4

<h4>Objectives</h4>The 2-hour accelerated diagnostic protocol (ADAPT) is a decision rule designed to identify emergency department (ED) patients with chest pain for early discharge. Previous studies in the Asia-Pacific region demonstrated high sensitivity (97.9% to 99.7%) for major adverse cardiac events (MACE) at 30 days. The objective of this study was to determine the validity of ADAPT for risk stratification in a cohort of U.S. ED patients with suspected acute coronary syndrome (ACS).<h4>Met ...[more]

PMID: 25810343

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Project description:PurposeTo determine radiation dose indexes for computed tomography (CT) performed with renal colic protocols in the United States, including frequency of reduced-dose technique usage and any institutional-level factors associated with high or low dose indexes.Materials and methodsThe Dose Imaging Registry (DIR) collects deidentified CT data, including examination type and dose indexes, for CT performed at participating institutions; thus, the DIR portion of the study was exempt from institutional review board approval and was HIPAA compliant. CT dose indexes were examined at the institutional level for CT performed with a renal colic protocol at institutions that contributed at least 10 studies to the registry as of January 2013. Additionally, patients undergoing CT for renal colic at a single institution (with institutional review board approval and informed consent from prospective subjects and waiver of consent from retrospective subjects) were studied to examine individual renal colic CT dose index patterns and explore relationships between patient habitus, demographics, and dose indexes. Descriptive statistics were used to analyze dose indexes, and linear regression and Spearman correlations were used to examine relationships between dose indexes and institutional factors.ResultsThere were 49 903 renal colic protocol CT examinations conducted at 93 institutions between May 2011 and January 2013. Mean age ± standard deviation was 49 years ± 18, and 53.9% of patients were female. Institutions contributed a median of 268 (interquartile range, 77-699) CT studies. Overall mean institutional dose-length product (DLP) was 746 mGy ⋅ cm (effective dose, 11.2 mSv), with a range of 307-1497 mGy ⋅ cm (effective dose, 4.6-22.5 mSv) for mean DLPs. Only 2% of studies were conducted with a DLP of 200 mGy ⋅ cm or lower (a "reduced dose") (effective dose, 3 mSv), and only 10% of institutions kept DLP at 400 mGy ⋅ cm (effective dose, 6 mSv) or less in at least 50% of patients.ConclusionReduced-dose renal protocol CT is used infrequently in the United States. Mean dose index is higher than reported previously, and institutional variation is substantial.

Project description:BackgroundIt is known that not all chiropractors follow mainstream guidelines on the use of diagnostic ionising radiation. Various reasons have been discussed in the literature, including using radiography to screen for congenital anomalies, to perform postural analysis, to search for contraindications to spinal manipulation, and to document chiropractic subluxations, i.e., tiny anatomical displacements of vertebrae thought to affect nerves and health. The visualisation of subluxations was the reason chiropractic first adopted the x-ray in 1910. There has never been a study of the influence of this historical paradigm of radiography on the practices of chiropractic radiologists (DACBRs or Diplomates of the American Chiropractic College of Radiology).MethodsA survey was administered with a modified Dillman method using SurveyMonkey and supplemented by hard copies distributed at a professional conference. The target population was all active DACBRs. There were 34 items, which consisted of multiple choice and open-ended interrogatives on all three areas in which chiropractic radiologists work: education, clinical practice, and radiology practice.ResultsThe response rate was 38% (73 of 190 DACBRs). Respondents reported that the historical paradigm of radiography was found in all areas of practice, but not as a major aspect. The majority of respondents did not condone that historical paradigm, but many tolerated it, particularly from referring chiropractors. Radiographic subluxation analysis was reportedly perpetuated by private clinical practitioners as well as technique instructors and supervising clinicians in the teaching institutions.ConclusionsWithin the chiropractic profession, there is a continuing belief in radiographically visible subluxations as a cause of suboptimal health. This situation is sustained in part due to the reticence of other chiropractors to report these practices to licensing and registration boards. Investigation into other structures supporting a vitalistic belief system over science in chiropractic is recommended. In addition, it may be useful to explore remunerative systems that move beyond the inherently conflicted fee-for-service model.

Project description:Rationale and objectivesThis study aimed to compare the volume computed tomography dose index (CTDIvol), dose length product (DLP), and size-specific dose estimate (SSDE), with the China and updated 2017 American College of Radiology (ACR) diagnostic reference levels (DRLs) in chest CT examinations of adults based on the water-equivalent diameter (Dw).Materials and methodsAll chest CT examinations conducted without contrast administration from January 2020 to July 2020 were retrospectively included in this study. The Dw and SSDE of all examinations were calculated automatically by "teamplay". The CTDIvol and DLP were displayed on the DICOM-structured dose report in the console based on a 32cm phantom.The differences in patient CTDIvol, DLP, and SSDE values between groups were examined by the one-way ANOVA. The differences in patient CTDIvol, DLP, and SSDE values between the updated 2017 ACR and the China DRLs were examined with one sample t-tests.ResultsIn total 14666 chest examinations were conducted in our study. Patients were divided into four groups based on Dw:270 (1.84%) in 15-20 cm group, 10287 (70.14%) in the 21-25 cm group, 4097 (27.94%) in the 26-30 cm group, and 12 (0.08%) patients had sizes larger than 30 cm. CTDIvol, DLP, and SSDE increased as a function of Dw (p<0.05). CTDIvol was smaller than SSDE among groups (p<0.05). The mean CTDIvol and DLP values were lower than the 25th, 50th, and 75th percentile of the China DRLs (p <0.05). The CTDIvol, DLP, and SSDE were lower than the 50th and 75th percentiles of the updated 2017 ACR DRLs (p <0.05) among groups.ConclusionsSSDE takes into account the influence of the scanning parameters, patient size, and X-ray attenuation on the radiation dose, which can give a more realistic estimate of radiation exposure dose for patients undergoing CT examinations. Establishing hospital's own DRL according to CTDIvol and SSDE is very important even though the radiation dose is lower than the national DRLs.

Dataset Information

Performance of the 2-hour accelerated diagnostic protocol within the American College of Radiology Imaging Network PA 4005 cohort.

Publications

Performance of the 2-hour accelerated diagnostic protocol within the American College of Radiology Imaging Network PA 4005 cohort.

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