Cause Of Hospital Death Research Articles

Surgical Embolectomy In Massive Acute Pulmonary Embolism: Our Experience

Background and Aims: Pulmonary embolism (PE) is the leading cause of hospital deaths among the non-surgical patients. Our aim was to evaluate the efficacy of surgical embolectomy in massive acute PE.Methods: It was a single centre, prospective study conducted between January 2007 and August 2013 in Specialized Cardiovascular Surgical Hospital of Nizhny Nizhny Novgorod State Medical Academy Nizhny Novgorod, Russia. One hundred and seventy five patients were diagnosed as PE. Only 77 patients were diagnosed as massive pulmonary embolism and were included in this study. Surgical embolectomy was performed without cardiopulmonary bypass through thoracotomy approach only in the involved pulmonary artery. Right atriotomy and evacuation of embolus was done, in cases of right ventricle thrombus.Results: Seventy-seven patients with acute massive PE underwent surgical embolectomy. Four (5.1%) patients died before discharge. Mean time of ICU stay was 70.1±11.0 hours. During six months of follow up after the embolotomy. Eleven (14%) patients had deep vein thrombosis, two had sub-massive PE. During 6 months of follow up 62 patients (81%) had no further episode of venous thrombloembolism.Conclusions: Our study showed surgical embolectomy can be done with good clinical outcome with acceptable mortality rate.Nepalese Heart Journal 2015;12(2):83-86

Risk factors for sepsis in Korean trauma patients.

Sepsis in severely injured patients is one of the leading causes of death in hospitals. The incidence of and risk factors for sepsis after trauma have been studied outside, but not within Korea. Therefore, this study investigated the incidence of sepsis and the independent risk factors for sepsis in moderately to severely injured patients in Korea. The electronic medical records of patients who visited the emergency department from January 2010 to December 2012 were reviewed retrospectively. Patients older than 18years of age with an Injury Severity Score (ISS) greater than or equal to nine points were included. A total of 183 patients met the study inclusion criteria. The median ISS was 14 (range 9-17) points and 15 (8%) patients developed sepsis. The patients' age [adjusted OR, 1.053; 95% confidence intervals (CI), 1.015-1.094], ISS (adjusted OR, 1.114; 95% CI, 1.046-1.187), and emergency surgery (adjusted OR, 3.727; 95% CI, 1.051-13.221) were independent risk factors for post-traumatic sepsis. Among the risk factors identified in the literature, our research confirmed only the patients' age and ISS as risk factors for sepsis after trauma, and, additionally, identified emergency surgery as a risk factor in Korean patients. Therefore, trauma patients who have any of the risk factors mentioned above have a high risk of post-traumatic sepsis, which requires certain precautionary clinical measures.

Epidemiological characteristics of chronic kidney disease of non-traditional causes in women of agricultural communities of El Salvador.

In El Salvador end-stage renal disease (ESRD) was the first cause of hospital mortality overall, the first cause of hospital deaths in men, and the fifth cause of hospital mortality in women in 2013. In agricultural communities, chronic kidney disease (CKD) occurs predominantly in male agricultural workers, but it also affects women to a lesser degree, even those who are not involved in agricultural work. Internationally, most epidemiological CKD studies emphasize men and no epidemiological studies focused exclusively on women. To describe the epidemiological characteristics of CKD in females in agricultural communities of El Salvador. A cross-sectional epidemiological study was carried out in 2009 - 2011 based on active screening for CKD and risk factors in women aged ≥ 18 years in 3 disadvantaged populations of El Salvador: Bajo Lempa (Usulután Department), Guayapa Abajo (Ahuachapán Department), and Las Brisas (San Miguel Department). Epidemiological and clinical data were gathered through personal history, as well as urinalysis for renal damage markers, determinations of serum creatinine and glucose, and estimation of glomerular filtration rates. CKD cases were confirmed at 3 months. Prevalence of CKD was 13.9% in 1,412 women from 1,306 families studied. Chronic kidney disease of nontraditional causes (CKDu), not attributed to diabetes mellitus, hypertension, or proteinuric primary glomerulopathy (proteinuria > 1 g/L) was 6.6%. Prevalence of chronic renal failure was 6.8%. Prevalence of renal damage markers was 9.8% (microalbuminuria (30 - 300 mg/L) 5.7%; macroalbuminuria (> 300 mg/L) 2%; and hematuria, 2.1%. Prevalence of chronic kidney disease risk factors was: diabetes mellitus, 9.3%; hypertension, 23%; family history of CKD, 16%; family history of diabetes mellitus (DM), 18.7%; family history of hypertension (HT), 31.9%; obesity, 21%; central obesity, 30.7%; NSAID use, 84.3%; agricultural occupation, 15.2%; and contact with agrochemicals, 33.1%. CKD in women of Salvadoran agricultural communities is associated with disadvantaged populations, traditional (DM, HT, obesity) and non-traditional causes (environmental and occupational exposure to toxic agents and inadequate working conditions). Our results reinforce the hypotheses emerging from other studies, suggesting a multifactorial etiopathology including environmental and occupational nephrotoxic exposure.

Preventing venous thromboembolism at a district hospital: a quality improvement study

Background: Pulmonary embolism (PE) is the most common preventable cause of hospital deaths, and almost all hospitalised patients have at least one risk factor for venous thromboembolism (VTE). Despite the availability of highly effective thromboprophylaxis in preventing VTE, numerous studies worldwide have demonstrated its under-utilisation. The aim of this study was to review and improve the utilisation of thromboprophylaxis in the prevention of VTE in hospitalised patients at Oudtshoorn district hospital, and to make recommendations to the Western Cape Department of Health on how to improve the quality of care for patients at risk for VTE at district hospitals.Method: A quality improvement cycle (QIC). Retrospective analysis of files of adult patients admitted to the male and female wards at Oudtshoorn district hospital was performed prior to and after a five-month intervention phase. The target standards for the QIC were: (1) availability of a written hospital policy on VTE prevention; (2) every adult...

Sepsis in Africa: practical steps to stem the tide.

Sepsis is a leading cause of morbidity and mortality worldwide and particularly in Africa where awareness is low and resources are limited. There are limited reports on the epidemiology, management and outcomes of the sepsis syndromes from Africa. However, this region is likely to account for a significant proportion of the global burden of sepsis which goes unrecognized. It is imperative to address this through research, increased awareness, capacity building and introduction of practical clinical guidelines. Infections are responsible for an estimated 300 million annual deaths worldwide, the majority from developing countries [1]. Sepsis can be triggered by almost any infection and is responsible for an estimated 8 million annual deaths worldwide [1]. In the United Kingdom (UK), sepsis is the third most important cause of death in hospital with an average management cost of £20,000 per admission [2]. Given the high incidence of Human Immunodeficiency Virus (HIV) and other infections in the African continent, it is likely that the burden of sepsis is at least equal if not higher than estimates from Europe and North America.

Septic shock: a major cause of hospital death after intensive care unit discharge.

ObjectiveTo assess the causes and factors associated with the death of patients between intensive care unit discharge and hospital discharge.MethodsThe present is a pilot, retrospective, observational cohort study. The records of all patients admitted to two units of a public/private university hospital from February 1, 2013 to April 30, 2013 were assessed. Demographic and clinical data, risk scores and outcomes were obtained from the Epimed monitoring system and confirmed in the electronic record system of the hospital. The relative risk and respective confidence intervals were calculated.ResultsA total of 581 patients were evaluated. The mortality rate in the intensive care unit was 20.8% and in the hospital was 24.9%. Septic shock was the cause of death in 58.3% of patients who died after being discharged from the intensive care unit. Of the patients from the public health system, 73 (77.6%) died in the intensive care unit and 21 (22.4%) died in the hospital after being discharged from the unit. Of the patients from the Supplementary Health System, 48 (94.1%) died in the intensive care unit and 3 (5.9%) died in the hospital after being discharged from the unit (relative risk, 3.87%; 95% confidence interval, 1.21 - 12.36; p < 0.05). The post-discharge mortality rate was significantly higher in patients with intensive care unit hospitalization time longer than 6 days.ConclusionThe main cause of death of patients who were discharged from the intensive care unit and died in the ward before hospital discharge was septic shock. Coverage by the public healthcare system and longer hospitalization time in the intensive care unit were factors associated with death after discharge from the intensive care unit.

Thromboprophylaxis use in medical inpatients and the impact of electronic risk assessment tool

▪Introduction:VTE is the third most common cause of hospital related deaths and the most common preventable cause of hospital death. Population based studies have continually emphasized the rising prevalence of VTE. As per data from CDC, VTE complicated about 550,000 hospitalizations each year in adults >18yrs. The prevalence was much higher in adults >60yrs and female sex. Pulmonary embolism accounts for about 5-10% of hospital deaths and the case fatality rates of DVT ranges between 1-10% mainly due to fatal PE and is highest in those with malignancies. VTE is associated with long term risks of post thrombotic syndrome and chronic thromboembolic pulmonary hypertension which contributes significantly to patient morbidity and cost of management.The ENDORSE trial assessed the proportion of at-risk medical patients who received thromboprophylaxis and determined that 39.5% (6119 out of 15487 patients) received ACCP-recommended VTE prophylaxis. The most effective strategies to improve prophylaxis consist of a system for reminding clinicians to assess patients for VTE risk, either electronic decision-support systems or paper-based reminders. In a recent study electronic VTE risk assessment tool (elVis) on VTE prophylaxis in hospitalised patients improved the prophylaxis rates by 5.0% amongst all patients and by 10.7% amongst high risk patients.Materials and Methods:This was a retrospective study to assess the effectiveness of a VTE (Venous Thrombo Embolism) risk assessment tool as part of the in hospital quality control initiative. A total of 400 charts were reviewed; 200 prior to implementation of the risk assessment tool, and 200 after. Patients with incomplete or missing data were excluded. A total of 388 patients were included in the study (Fig 1). These patients were randomly picked in the pre and post implementation phases of the study (April 2011 and October 2011 respectively). The hospital committee designed the risk assessment tool based on the ACCP guidelines with few modifications individualized to our patient population.The tool was an automatic and mandatory pop op that would guide the admitting resident in making a decision about VTE prophylaxis. After the tool was implemented (July 2011), all house staff were educated on its use by a dedicated lecture during a noon conference session.Results:Demographics and results of the study are shown via the following table: Table 1Pre-VTE toolPost-VTE toolNumber of patients189199Male47.9%49.7%Moderate –High Risk57.1%61.3%Individual Risk FactorsPrior VTE13.7%15.7%Chronic Pulm Disease17.9%19.1%Chronic Heart Failure14.4%16.9%Long term immobility11.7%17.4%Obesity37.2%34.3%Thrombophilia1.2%1.1%Malignancy4.6%4.7%Contraindications to anticoagulation19.04%19.06%Treatment Correctness56.3%80.3%Conclusions:This study gives us insight that VTE risk assessment tool accompanied with staff education improves VTE prophylaxis in at risk medicine inpatients. Study also confirms that incorporation of VTE prophylaxis guidelines in routine clinical practice can be assisted by electronic assessment and decision support tools. DisclosuresNo relevant conflicts of interest to declare.

Tromboembolia de pulmón

Pulmonary thromboembolism (PTE) is the third cause of cardiovascular death after acute myocardial infarction and ictus and is the first cause of preventable death in hospital. The diagnosis requires the assessment of the clinical probability, D-dimer outcomes and imaging test. Most patients respond favorably to anticoagulant therapy. Fibrinolytic therapy is reserved for cases beginning as hemodynamic instability. The minimum duration of therapy must be extended to 3 months. Longer treatment should be assessed in patients with idiopathic PTE or with persistent risk of thrombosis.

Systematic review of statistics on causes of deaths in hospitals: strengthening the evidence for policy-makers.

ObjectiveTo systematically review the reliability of hospital data on cause of death and encourage periodic reviews of these data using a standard method.MethodsWe searched Google Scholar, Pubmed and Biblioteca Virtual de la Salud for articles in English, Spanish and Portuguese that reported validation studies of data on cause of death. We analysed the results of 199 studies that had used medical record reviews to validate the cause of death reported on death certificates or by the vital registration system.FindingsThe screened studies had been published between 1983 and 2013 and their results had been reported in English (n = 124), Portuguese (n = 25) or Spanish (n = 50). Only 29 of the studies met our inclusion criteria. Of these, 13 had examined cause of death patterns at the population level – with a view to correcting cause-specific mortality fractions – while the other 16 had been undertaken to identify discrepancies in the diagnosis for specific diseases before and after medical record review. Most of the selected studies reported substantial misdiagnosis of causes of death in hospitals. There was wide variation in study methodologies. Many studies did not describe the methods used in sufficient detail to be able to assess the reproducibility or comparability of their results.ConclusionThe assumption that causes of death are being accurately reported in hospitals is unfounded. To improve the reliability and usefulness of reported causes of death, national governments should do periodic medical record reviews to validate the quality of their hospital cause of death data, using a standard.

Safety signal detection: the relevance of literature review.

Adverse drug reactions (ADRs) represent an important risk for patients and have a significant economic impact on health systems. ADRs are the fifth most common cause of hospital death, with a burden estimated at 197,000 deaths per year in the EU. This has a societal cost of <euro>79 billion per year. Because of this strong impact in public health, regulatory authorities (RAs) worldwide are implementing new pharmacovigilance legislation to promote and protect public health by reducing the burden of ADRs through the detection of safety signals. Although, traditionally, signal detection activities have mainly been performed based on spontaneous reporting from healthcare professionals and national health RAs, the new pharmacovigilance legislation underlines the relevance of other sources of information (such as scientific literature) for the evaluation of the benefit-risk balance of a certain product. This review aims to highlight the relevance of periodic scientific literature screening in the safety signal detection process. The authors present four practical examples where a safety signal that was detected from a literature report had an impact on the lifecycle of a drug. In addition, based on practical experience of the screening of medical and scientific literature for safety purposes, this article analyses the requirements of the new pharmacovigilance guidelines on literature screening and highlights the need for the implementation of a literature review procedure and the main challenges encountered when performing literature screening for safety aspects.

Dopamine mediates vagal modulation of the immune system by electroacupuncture

Previous anti-inflammatory strategies against sepsis, a leading cause of death in hospitals, had limited efficacy in clinical trials, in part because they targeted single cytokines and the experimental models failed to mimic clinical settings [1-3]. Neuronal networks represent physiological mechanisms, selected by evolution to control inflammation, that can be exploited for the treatment of inflammatory and infectious disorders [3].

Effects of mesenchymal stromal cells on human umbilical vein endothelial cells in in vitro sepsis models

Septic shock is a medical emergency that, despite the medical advances that have been made, still remains a major cause of hospital deaths. Cell therapy is an innovative field of research that could provide a therapy for sepsis. Mesenchymal stromal cells (MSC) are promising in cell therapy and more importantly for sepsis because of their immunosuppressive capabilities [1]. MSC have been shown by several groups to have a positive effect against sepsis in vivo [2-4]. It has been predicted that the MSC interact with macrophage to release IL-10 that in turns reduces inflammation [4]. Other groups have focused on the use of stimulated MSC to ameliorate their immunosuppressive capabilities [5]. The main stimulation of MSC has been the use of inflammatory stimulants like IFNγ. Our work focuses on the identification of effective MSC donors, whether primed with IFNγ or naive, and the development of in vitro models that will predict how an MSC donor will act in vivo. We also want to eliminate the use of cells completely and use their secreted microvesicles as a therapy. The hypothesis is that the in vitro models will eliminate a noneffective MSC donor and allow us to identify the MSC donor that will have the greatest effect.

Dopamine mediates vagal modulation of the immune system by electroacupuncture

Previous anti-inflammatory strategies against sepsis, a leading cause of death in hospitals, had limited efficacy in clinical trials, in part because they targeted single cytokines and the experimental models failed to mimic clinical settings1-3. Neuronal networks represent physiological mechanisms selected by evolution to control inflammation that can be exploited for the treatment of inflammatory and infectious disorders3. Here, we report that sciatic nerve activation with electroacupuncture controls systemic inflammation and rescues mice from polymicrobial peritonitis. Electroacupuncture at the sciatic nerve controls systemic inflammation by inducing a vagal activation of DOPA decarboxylase leading to the production of dopamine in the adrenal medulla. Experimental models with adrenolectomized animals mimic clinical adrenal insufficiency4, increase the susceptibility to sepsis, and prevent the anti-inflammatory potential of electroacupuncture. Dopamine inhibits cytokine production via dopaminergic type-1 receptors. Dopaminergic D1-agonists suppress systemic inflammation and rescue mice from polymicrobial peritonitis in animals with adrenal insufficiency. Our results suggest a novel anti-inflammatory mechanism mediated by the sciatic and the vagus nerves modulating the production of catecholamines in the adrenal glands. From a pharmacological perspective, selective dopaminergic agonists mimic the anti-inflammatory potential of electroacupuncture and can provide therapeutic advantages to control inflammation in infectious and inflammatory disorders.

Evaluation of hospital nurses' perceived knowledge and practices of venous thromboembolism assessment and prevention

Venous thromboembolism (VTE) is a preventable cause of hospital death. Bedside registered nurses (RNs) are a key group that can be the first to recognize risks of patients in acute care settings. The purpose of this study was to identify bedside hospital RNs' perceived knowledge of VTE, their assessment practices, their self-efficacy in conducting VTE prevention care, and their perceived barriers to performing VTE risk assessment. An anonymous web-based survey on VTE risk assessment and prevention was conducted with RNs who provided direct patient care at two hospitals. RNs who were not directly involved in bedside patient care such as managers and educators were excluded. A total of 221 RNs completed the survey. Most participants rated their overall knowledge of VTE risk assessment between "good" (44%) and "fair" (28%). VTE assessment frequencies performed by participants varied widely. Participants reported high confidence in their ability to educate patients and families about VTE symptoms, prevention, and treatments. Participants were least confident in their own ability to conduct a thorough VTE risk assessment. Greater self-reported VTE knowledge was associated with greater VTE assessment frequency and self-efficacy for VTE preventive care. The most common perceived barriers in performing VTE risk assessment were lack of knowledge (21%) and lack of time (21%). The findings demonstrate a substantial need for focused education about VTE prevention for hospital nurses and support for hospital systems to monitor VTE care. Despite the Joint Commission emphasis on VTE risk assessment in all hospitalized patients, there remains a gap between current, evidence-based recommendations for VTE prevention and reported nursing practices.

Chronic kidney disease and associated risk factors in two Salvadoran farming communities, 2012.

Chronic kidney disease is a global pandemic, affecting the majority of countries in the world. Its prevalence is approximately 10% and it is associated mainly with diabetes and high blood pressure. In El Salvador, it is the leading cause of hospital deaths among men. Determine prevalence of chronic kidney disease and its risk factors in two Salvadoran farming communities. From March through September 2012, a descriptive cross-sectional study was conducted in two Salvadoran farming communities: Dimas Rodríguez (El Paisnal municipality) and El Jícaro (San Agustín municipality). The research involved both epidemiological and clinical methods. An active search for chronic kidney disease and its risk factors was carried out in the population aged >15 years. House-to-house visits were carried out to take family and individual health histories and gather data on social conditions and risk factors. A physical examination was performed, along with laboratory tests (urinalysis and blood chemistry) to measure renal function and detect markers for renal damage. A total of 223 persons of both sexes were studied. Overall prevalence of chronic kidney disease was 50.2%. Prevalence of chronic renal failure was 16.1%, with slight variations between the sexes. In El Jícaro, 77.3% of participants reported contact with agrochemicals and 76.6% were farmworkers; the respective figures for Dimas Rodríguez were 75.8% and 73.7%. The next most frequently reported risk factor was NSAID use, at 61.7% in El Jícaro and 77.9% in Dimas Rodríguez. CKD prevalence is alarming in these communities, among both young and old, men and women, independently of occupation. Health services must cope with the increased CKD burden observed, and are challenged to implement preventive strategies.

Epidemiology of chronic kidney disease in adults of Salvadoran agricultural communities.

In El Salvador, chronic kidney disease is a serious and growing public health problem. Chronic renal failure was the first cause of hospital deaths in men and the fifth in women in 2011. Determine prevalence of CKD, CKD risk factors (traditional and nontraditional) and renal damage markers in the adult population of specific rural areas in El Salvador; measure population distribution of renal function; and identify associated risk factors in CKD patients detected. A cross-sectional analytical epidemiological study was conducted based on active screening for chronic kidney disease and risk factors in persons aged ≥18 years during 2009-2011. Epidemiological and clinical data were gathered through personal history, as well as urinalysis for renal and vascular damage markers, determinations of serum creatinine and glucose, and estimation of glomerular filtration rates. Chronic kidney disease cases were confirmed at three months. Multiple logistical regression was used for statistical analysis. Prevalence of chronic kidney disease was 18% (23.9% for men and 13.9% for women) in 2388 persons: 976 men and 1412 women from 1306 families studied. Chronic kidney disease with neither diabetes nor hypertension nor proteinuria ≥1 g/L (51.9%) predominated. Prevalence of chronic renal failure was 11% (17.1% in men and 6.8% in women). Prevalence of renal damage markers was 12.5% (higher in men): microalbuminuria, 6.9%; proteinuria (0.3 g/L), 1.7%; proteinuria (1g/L), 0.6%; proteinuria (2 g/L), 0.4 %; and hematuria, 1.5%. Prevalence of chronic kidney disease risk factors was: diabetes mellitus, 9%; hypertension, 20.9%; family history of chronic kidney disease, 16.5%; family history of diabetes mellitus, 18.5%; family history of hypertension, 30.6%; obesity, 21%; central obesity, 24.9%; NSAID use, 84.2%; smoking, 9.9%; alcohol use, 15%; agricultural occupation, 31.2%; and contact with agrochemicals, 46.7%. Chronic kidney disease was significantly associated with male sex, older age, hypertension, agricultural occupation, family history of chronic kidney disease and contact with the agrochemical methyl parathion. The results of this study support suggestions from other research that we are facing a new form of kidney disease that could be called agricultural nephropathy.

Factors Associated With the General Public Knowledge and Awareness of Cardiovascular Diseases and its Risk Factors in Penang – Malaysia

Background: Cardiovascular diseases(CVDs) are the top of the ten causes of hospital deaths in Malaysia. Increasing knowledge and awareness on CVDs and its risk factors is crucial for the prevention of CVDs. Identification of factors which are associated with the knowledge and awareness is important for the proper design of future awareness programs. Objectives: This study was carried out to find out factors which are associated with the current knowledge and awareness of cardiovascular diseases (CVDs) and its risk factors among the general public in PenangMalaysia. Method: Four hundred and fifty-six (456) from the general public participated in the study by filling a structured questionnaire offered in three languages, English, Malay and Chinese. The knowledge and the awareness scores were computed as continuous variables then simple liner regression (SLR) followed by general linear regression (GLR) were used to find factors associated with the levels of knowledge and awareness. Findings: The GLR final model revealed that the knowledge and awareness of CVDs and its risk factors was associated with the level of education, the previous attendance of health campaign on CVDs and having any CVDs or family history of CVDs. Conclusion: The study provides insights into factors associated with the knowledge and awareness of CVDs and its risk factors among the general public. Tailored awareness programs are required to address specific demographic groups of the general public.

Preventing Venous Thromboembolism in the Critically Ill — Can We do More?

Pulmonary embolism is the most common preventable cause of hospital death; and of all the different patient groups, the critically ill are particularly at risk of venous thromboembolism. Most critically ill patients have multiple risk factors. Clinical trials have shown that the use of low molecular weight heparin (LMWH) is safer than unfractionated heparin in this population. Further trials are required to look at the risks and benefits of dose adjusting LMWH at the extremes of weight, in patients with renal failure and those on antiplatelet agents. Heparin-induced thrombocytopenia is still a risk with LMWHs so a safer anticoagulant such as fondaparinux and even the new oral anticoagulants merit trials. Further evidence is also needed for the use of graduated compression stockings and pneumatic devices.

P160 Retrospective study analysing whether optimization of pulmonary vascular enhancement influences diagnostic outcome in the interpretation of CT pulmonary angiograms (CTPA)

Introduction and Objectives Pulmonary embolism (PE) is a common cardiovascular emergency and is the most common preventable cause of hospital deaths. Various factors can impact on the diagnostic accuracy of CTPA, which is now considered the 1 st line investigation for PE diagnosis. Mis-timing of contrast medium administration or cardiac impairment can result in an indeterminate scan through hidden or mimicked emboli. This study focuses on the accuracy of CTPAs in excluding a diagnosis of PE. Method This is a single centre study looking at all inpatient and outpatient CTPAs carried out over a 12-month period with matched CTPA and lower limb ultrasound Doppler events selected. Of these matched studies, all positive CTPAs for PE were excluded. Of the remainder, only those studies done within 6 months of the original CTPA were included in the study. CT pulmonary arterial (PA) opacification with intravenous contrast medium was objectively measured in Hounsfield units (HU) using an oval region of interest in the main pulmonary trunk. PA opacification was categorised as very poor ( Results From the 32 CTPAs included in the study, 28 had a negative initial CTPA with subsequent negative CT or US follow-up. 4 of these cases had an initial negative CTPA with a subsequent positive CTPA or lower limb US Doppler study. Of these latter cases only one initial CTPA was deemed poorly suboptimal (average 174HU) with optimal pulmonary arterial opacification in all other three initial CTPAs. Conclusion This study demonstrates that despite a large number of initially negative CTPAs undergoing subsequent follow-up imaging due to presumed persistent or recurring patient symptoms, the majority (87.5%) of these negative scans were still negative and only 12.5% were positive for PE. No major pitfall has been identified in local CTPA acquisition technique that may have led to subsequent misses of potentially life-threatening PEs.

Postoperative Venous Thromboembolism Prophylaxis by General Surgeons in a Developing Country: A Survey

Venous thromboembolism (VTE) is the most common preventable cause of hospital death. Several audits in the west have demonstrated that appropriate thromboprophylaxis is not being offered to a large number of surgical patients. Similar audits are lacking in the Indian population, and a perception exists among Indian surgeons that Indian patients are not susceptible to VTE. Hence we undertook a survey to analyze the existing knowledge and practice of VTE prophylaxis amongst general surgeons in India. A questionnaire-based survey was conducted on 100 active general surgeons. We found that 97% of surgeons had encountered VTE in their practice, and 49% had encountered mortality from pulmonary embolism. 64% of surgeons do not routinely score patients preoperatively for their VTE risk, and only 33% reported the presence of an institute-based protocol for the same. There was a wide disparity in the prophylaxis methods used for each risk group, particularly in the moderate-risk group. These findings suggest the need for adoption of institute-based protocols for prophylaxis and the evolution of Indian guidelines for VTE prophylaxis.