non-CT Groups Research Articles

The lasting effects of childhood trauma on developing psychiatric symptoms: A population-based, large-scale comparison study.

Childhood trauma (CT) increases rates of psychiatric disorders and symptoms, however, the lasting effect of CT into adulthood has little exploration using large-scale samples. This study estimated the prevalence of CT in a large sample of Chinese young adults, examining the risk factors of current psychological symptoms among those with CT experiences. 117,769 college students were divided into CT and non-CT groups. The propensity score matching method balanced the confounding sociodemographic factors between the two groups, compared to 16 self-reported psychiatric disorders (e.g., depression, anxiety, eating disorder, obsessive-compulsive disorder, autism, social anxiety disorder, post-traumatic stress disorder), and seven current psychiatric symptoms. Hierarchical regression employed the significant risk factors of the seven current psychiatric symptoms. The prevalence of CT among young adults was 28.76% (95% CI: 28.47-29.04%). Youths with CT experiences reported higher psychiatric disorder rates and current symptom scores (P < 0.001). Sociodemographic factors (females, family disharmony, low socioeconomic status, poor relationship with parents, lower father's education level) and lifestyle factors (smoking status, alcohol consumption, lack of exercise) were significantly associated with current psychiatric symptoms. Public health departments and colleges should develop strategies to promote mental health among those who have experienced CT.

Preoperative computed tomography in Fournier's gangrene does not delay time to surgery.

Fournier's gangrene (FG), a rapidly progressive necrotizing soft tissue infection of the external genitalia and perineum, necessitates urgent surgical debridement. The time to surgery effect of preoperative computed tomography (CT) in managing this condition is yet to be fully explored. The purpose of this study was to assess whether obtaining a preoperative CT in patients with FG impacts the time to surgical intervention. This was a single-center retrospective study of patients who underwent CT prior to surgical debridement of FG during a 9-year period vs patients who did not undergo CT. In 76 patients (male = 39, mean age = 51.8), 38 patients with FG received a preoperative CT, and 38 patients with FG did not receive CT prior to surgical debridement. Time to operating room and outcome metrics were compared between CT and non-CT groups. The time from hospital presentation to surgical intervention was not significantly different between patients who underwent CT and those who did not (6.65 ± 3.71 vs 5.73 ± 4.33 h, p = 0.37). There were also no significant differences in cost ($130,000 ± $102,000 vs $142,000 ± $152,000, p = 0.37), mortality (8 vs 7, p = 1), duration of hospital stay (15.5 ± 15 vs 15.7 ± 11.6 days, p = 0.95), average intensive care unit stay (5.82 ± 5.38 days vs 6.97 ± 8.58 days, p = 0.48), and APACHE score (12 ± 4.65 vs 13.9 ± 5.6, p =0.12). Obtaining a preoperative CT did not delay surgical intervention in patients with FG.

Analysis of prognosis in different subtypes of invasive lobular carcinoma using the Japanese National Cancer Database-Breast Cancer Registry.

Many studies have shown that the prognosis of invasive lobular carcinoma (ILC) is better than that of invasive ductal carcinoma (IDC). However, both disorders exhibit different prognoses according to molecular subtype, and the prognosis of ILC subtypes might depend on their hormone receptor positivity rate. This study clarified the prognosis of ILC and IDC in each subtype and examined the effectiveness of adjuvant chemotherapy (CT) in luminal ILC. We planned the analysis using data from the Breast Cancer Registry in Japan. Because it was presumed that there are differences in characteristics between ILC and IDC, we created matched cohorts using exact matching to compare their prognoses. We compared the prognosis of ILC and IDC for each subtype. We also compared the prognosis of luminal ILC between the CT and non-CT groups. For all subtypes, the disease-free survival (DFS) and overall survival (OS) of ILC were poorer than those of IDC. In the analysis by each subtype, no statistically significant difference was found in DFS and OS in luminal human epidermal growth factor 2 (HER2), HER2, and triple-negative cohorts; however, luminal ILC had significantly poorer DFS and OS than luminal IDC. The CT effects on the prognosis of luminal ILC were greater in more advanced cases. Luminal ILC had a poorer prognosis than luminal IDC, contributing to the worse prognosis of ILC than that of IDC in the overall cohort. Different therapeutic approaches from luminal IDC are essential for a better prognosis of luminal ILC.

Cardiotoxicity surveillance among patients with cancer treated with immunotherapy.

2636 Background: With the advancements of immunotherapy procedures and, more specifically, immunological checkpoint inhibitors (ICIs), the scenario of cancer treatment, whether in its early or advanced stages, have changed. With the expansion of ICIs usage, cardiovascular toxicities have been reported, but more robust data are needed to guide the follow-up of patients and toxicity prevention. Methods: This research is a single-centered, prospective observational cohort study that evaluated patients treated with ICIs regardless of indication, with or without chemotherapy combination. Patients underwent echocardiography evaluation with global longitudinal strain (GLS) and myocardial work, electrocardiogram, and collection of biomarkers before the start of treatment, in the second month after treatment started, and every 3 months, subsequently. Evaluations stopped once treatment completed one year, or the medication was discontinued either due to toxicity or disease progression. Cardiotoxicity (CT) was defined by ≥ 10% reduction in left ventricular ejection fraction (LVEF) by less than 50%, troponin elevation by ≥ 0,30 ng/ml, or reduction in relative GLS by ≥ 15%. Frequencies were compared using Fisher's comparative test, as appropriate, and Mann-Whitney test for numerical variables. Statistical significance will be considered as p &lt; 0.05 for two-tailed tests. Results: Outof the 98 patients scheduled for treatment, 39 patients underwent at least 2 evaluations and had their exams analyzed. There was a 26% incidence of overall CT, with half of these patients by LVEF reduction criteria and, considering only patients with lung cancer, there was an incidence of 35% with CT. Dividing the total sample into CT and non-CT groups, a higher number of men, smokers and patients with lung cancer was observed, as well as a lower LVEF baseline (67% vs 62.50, p = 0.014) in the CT group. Concomitant chemotherapy or higher baseline coronary calcium scores did not appear to increase the risk of CT among patients, but the use of beta-blockers was restricted to patients who did not develop an event. There was a reduction in myocardial work parameters in the 2nd month assessment: global index (GWI) 1833 vs 2334, p = 0.006, constructive work (GCW) 2299 vs 2683, p = 0.040, and work efficiency (GWE) 83 vs 95, p = 0.025 and tendency towards increased myocardial work loss (GWW) 286 vs 116, p = 0.064, in the comparison between groups. Those who met CT criteria had a longer overall survival, as did those who developed other immune-mediated adverse events and metformin users. Conclusions: This was the first study that carried out cardiotoxicity surveillance in patients undergoing immunotherapy, with a surprising finding of events in a small but high-risk sample. The development of immune-mediated toxicities seems to be related with therapeutic response. Also, the use of metformin seems to contribute to this response, as already demonstrated in preclinical studies.

The Prognostic Significance of Adjuvant Chemotherapy in Adult Ovarian Granulosa Cell Tumors: A Systematic Review and Meta-analysis.

This study aimed to evaluate the oncological and prognostic significance of adjuvant chemotherapy (CT) in patients with adult granulosa cell tumors of the ovary (AOGCT). We searched the Chinese National Knowledge Infrastructure, Clinical Trials, Wanfang Database, Web of Science, Cochrane Library, and MEDLINE electronic databases for articles published up to May 2023. Reference lists of the enrolled studies, Google Scholar, and scientific meeting reports were also manually searched. We enrolled 5641 patients with AOGCT from 33 eligible studies, including 1674 (29.7%) and 3967 (70.3%) patients in the CT and non-CT groups, respectively. Based on the cumulative results, adjuvant CT did not affect the risk of recurrence or progression (R/P) (odds ratio [OR]: 1.67, 95% confidence interval [CI]: 1.01-2.78, I2 = 63%, P = .05) and 5-year overall survival (OR: .86, 95% CI: .70-1.04, I2 = 0%, P = .12) of patients with AOGCT. However, adjuvant CT might reduce the 5-year disease-free survival (OR: 2.90, 95% CI: 1.19-7.08, I2 = 55%, P = .02). Sub-group analysis revealed that adjuvant CT did not affect the risk of R/P in patients with early-stage AOGCT (OR: .78, 95% CI: .43-1.43, I2 = 2%, P = .43) and advanced or recurrent AOGCT (OR: .78, 95% CI: .43-1.43, I2 = 2%, P = .43). This meta-analysis suggests that patients with AOGCT might not benefit from adjuvant CT, even those with advanced or recurrent disease. The results should be interpreted with caution because of the inherent limitations of retrospective studies.

Patient Experience in Clinical Trials: Quality of Life, Financial Burden, and Perception of Care in Patients With Multiple Myeloma or Lymphoma Enrolled on Clinical Trials Compared With Standard Care.

Patients' concerns regarding clinical trial (CT) participation include apprehension about side effects, quality of life (QoL), financial burden, and quality of care. We prospectively evaluated the experience of patients with multiple myeloma or lymphoma who were treated on CTs (CT group, n = 35) versus patients treated with standard approaches (non-CT group, n = 88) focusing on QoL, financial burden of care, and patients' perception of quality of care over a 1-year period. There were no significant differences in any of the patient-reported outcomes in CT versus non-CT groups. We observed an initial decline in overall QoL in the first 3 months across both groups, driven primarily by physical and functional well-being. QoL gradually improved and was above baseline by month 12. Patients reported highest improvement in the functional well-being subdomain. Patients in both groups reported high satisfaction with the quality of care received, and there were no differences in overall satisfaction, communication with team, or access to care. At baseline, 16%-19% of patients reported financial burden, which increased to a peak of 33% in the CT group and to 49% in the non-CT group over the course of 1 year. There was no significant difference in financial burden in the two groups overall. Most of the patients reported getting all the care that was deemed medically necessary in both groups. However, a significant proportion of patients reported having to make other kinds of financial sacrifices because of their cancer (CT group: 33% of patients at baseline and 21%-40% over 1 year; non-CT group: 19% at baseline and 25%-36% over 1 year). Patients treated on CTs reported comparable QoL and quality of care with the non-CT group. A high proportion of patients reported financial burden over time in both groups. Our findings can serve as a guide to educate patients regarding CT participation and highlight the need to address the significant financial burden experienced by patients with cancer.

Balint in the time of COVID-19: participant and facilitator experience of virtual Balint groups compared with in-person

AimsOur Trust increased Balint group provision, relocating virtually for psychiatry doctors to explore the emotional impact of clinical practice and doctor-patient relationships, during unfamiliar challenges of the pandemic. This unique context allowed comparison of multiple virtual and face-to-face (F2F) Balint-type group experiences for participants and facilitators.MethodIn March 2020, existing core trainee (CT) year 1 and 2, higher trainee (ST) and consultant Balint groups became virtual, with new CT3 and Speciality Doctor and Associate Specialist (SAS) virtual Balint groups established.All 57 participants and 5 facilitators were sent an anonymous electronic survey to retrospectively rate virtual Balint (March-August 2020) and their preceding F2F Balint group (suggesting September 2019-February 2020) experience.ResultThe response rate was 89% for participants (51 respondents) and 100% for facilitators (5 respondents).For group participants, 90% (virtual) and 78% (F2F) agreed or strongly agreed that Balint group provided an opportunity to explore challenging aspects of clinical work. 76% (virtual) and 71% (F2F) agreed or strongly agreed that it made them feel more supported. Almost 50% agreed or strongly agreed that virtual and F2F Balint group helped work feel less stressful. Both ratings and free-text feedback emphasised virtual Balint attendance being easier.Facilitators rated virtual and F2F formats similarly highly with regards to exploring difficult doctor-patient interactions, richness of discussions and their enjoyment. Facilitators felt virtual attendance was easier but more draining, with more difficult adherence to Balint group etiquette and boundaries.82% of participants and 75% of facilitators agreed or strongly agreed that virtual format made them more likely to attend future Balint groups. The rich pool of free-text comments received were predominantly positive, whilst noting challenges during virtual Balint in remaining present, with more distractions (for participants) and additional difficulty accessing group dynamics (for facilitators).ConclusionParticipant and facilitator responses indicate Balint-type groups being professionally and clinically beneficial across different psychiatrist grades, and promoting clinician wellbeing when both F2F and virtual during pandemic-related restrictions. Facilitator ratings (unlike participants) suggested specific virtual process challenges such as feeling more drained, perhaps in part due to technical application issues around this emerging format.Both participants and facilitators reported attendance being easier when virtual. Although some suggested returning to F2F post-COVID, more preferred to continue virtually or utilise a blended format. This was particularly for non-CT groups where geographical challenges (e.g. region-wide ST Balint) or competing clinical demands (e.g. consultant/SAS Balint) made regular commitment and attendance more difficult.

Associations of P Score With Real-World Survival Improvement Offered by Adjuvant Chemotherapy in Stage II Colon Cancer: A Large Population-Based Longitudinal Cohort Study.

BackgroundBased on a prognostic scoring system (P score) proposed by us recently, this retrospective large population-based and propensity score-matched (PSM) study focused on predicting the survival benefit of adjuvant CT in stage II disease.MethodsPatients diagnosed with stage II colon cancer (N = 73397) were identified from the Surveillance, Epidemiology, and End Results database between January 1, 1988 and December 31, 2005 and divided into the CT and non-CT groups. PSM balanced the patient characteristics between the CT and non-CT groups.ResultsThe magnitude of CSS improvement among patients treated with adjuvant CT was significantly associated with the P score, score 8 [hazard ratio (HR) = 0.580, 95% confidence interval (CI) = 0.323–1.040, P = 0.067] was associated with a much higher increased CSS benefit among patients treated with adjuvant CT as compared to score 2* (*, including scores 0, 1, and 2; HR = 1.338, 95% CI = 1.089–1.644, P = 0.006).ConclusionsHigh P scores were demonstrated to be associated with superior survival benefit of adjuvant CT. Therapy decisions of adjuvant CT in stage II colon cancer could be tailored on the basis of tumor biology, patient characteristics and the P score.

Quality of life (QOL), financial burden, and perception of care in patients enrolled on clinical trials (CTs).

e19112 Background: We sought to study the longitudinal QOL, financial burden and perception of care (PoC) in patients with multiple myeloma (MM) or lymphoma (LYM) enrolled on CTs vs. those receiving standard care (Non-CT). Methods: QOL was evaluated using the FACT-G questionnaire (baseline, 1, 2, 3, 6 &amp; 12 months). Financial burden was evaluated using 10 questions adapted from the MEPS survey and PoC was evaluated using 6 questions adapted from the CAHPS survey (baseline, 3, 6 &amp; 12 months). Results: 35 (28%) of 123 enrolled patients were treated on CTs. Demographics, QOL and financial burden are shown in the Table. Baseline QOL scores were similar in CT vs non-CT groups. Age, gender and self-reported performance status were significantly associated with baseline QOL, while lines of therapy &amp; cancer type were not. There were no significant differences in change in QOL vs. baseline in patients treated on CTs vs. non-CTs at 1, 2, 3, 6 and 12 months from baseline, including the total FACT-G score and the subdomains of functional, physical, emotional and social well-being. Within each group, there was a decline in QOL over the first 3 months, specifically physical WB, which gradually returned to baseline. Baseline answers to financial burden questions were similar, except patients on CTs reported less need for taking extended time-off from work (22% vs. 46%, p = 0.02). The only statistically significant difference in individual Qs over 1 year was ‘worry about having to pay large medical bills’ at the 6-month timepoint (CT: 0%, non-CT: 52%, p = 0.01). Using a composite score from 4 MEPS questions, financial burden over time was lower in the CT group, though the differences were not statistically significant. There were no significant differences in PoC at baseline, 3, 6 and 12 months in the two groups based on answers to each of the six questions adapted from the CAHPS survey. Conclusions: Over 1 year, patients on CTs experienced a similar QOL and perceived their care to be similar as non-CT patients. Financial burden was lower in the CT group, though differences were not statistically significant. [Table: see text]

Abstract P1-13-07: Effect of adjuvant chemotherapy for patients with ER-positive/HER2-negative breast cancer assessed by the propensity score matching: Significance of nuclear grade and nodal status

Abstract Purpose: Although a survival benefit with chemotherapy (CT) is obtained over all among patients with estrogen receptor-positive (ER+) breast cancer, the degree of benefit differs among the subtypes. The 21-gene Recurrence Score assay is a validated prognostic/predictive tool for early ER+ breast cancer. However, genomic assays have not been approved in Japan and most other countries, except in some developed countries. Based on the St. Gallen 2015, 1-3 positive nodes are not an absolute indication for CT among patients with ER+/HER2-negative breast cancer. In contrast, it is better for CT to be performed except for low-risk groups, based on genomic tests according to the St. Gallen 2017. In fact, no prospective study has proven the survival benefit of CT specifically for luminal-A breast cancer. Therefore, we analyzed the survival benefit of CT for ER+/HER2-negative breast cancer by propensity score matching (PSM). Patients and methods: Between 2000 and 2015, 895patients with stage I-III ER+/HER2-negative breast cancer who had underwent surgery in our hospital were examined. Patients with bilateral breast cancer, ER&amp;lt;10%, and preoperative treatment were excluded. The primary end point was the 5-year recurrence-free survival (RFS) and overall survival (OS) in patients matched by propensity score that estimated by a logistic regression model that included factors likely to influence the decision of whether or not to administer CT (tumor size, nuclear grade [NG], progesterone receptor status and nodal status). Results: In the entire cohort, the median age was 59 (28-95) years; 223 patients (24.9%) were node positive and 126 patients (14.1%)had NG3 disease. Overall, all patients received endocrine therapy, and 24.1% received additional CT. After a median follow-up of 68.8 months, the 5-year RFS rate was 94.3% in CT-untreated patients (non-CT group) and 90.1% in CT-treated patients (CT group; hazard ratio [HR] for recurrence, 1.47; 95% confidence interval [CI], 0.90 -2.33; p=0.106). The 5-year OS rate was 97.5% in the non-CT group and 95.6% in the CT group (HR for death, 1.80; 95% CI, 0.99-3.21; p=0.047). Using PSM, 236 patients were selected (1:1 matching between non-CT and CT groups). After matching, the 5-year RFS rate was higher in the CT group than in the non-CT group (96.8% vs. 82.7%; HR for recurrence, 0.29; 95% CI, 0.11-0.68; p=0.003), and the 5-year OS rate was higher in the CT group than in the non-CT group (100% vs. 91.9%; HR for death, 0.06; 95% CI, 0.003-0.35; p&amp;lt;0.001). Among PSM patients, with node-negative/NG3 and 1-3 node positive/NG2 disease, the 5-year RFS rate was significantly higher in the CT group than in the non-CT group (p=0.041 and p=0.006, respectively). Conclusion: No significant benefit of CT was observed when considering the entire cohort because of the treatment bias. When clinical and tumor features were matched by propensity score, the addition of CT significantly improved both RFS and OS of ER+/HER2-negative breast cancer patients, especially for patients with node- negative/NG3 and 1-3 node positive/NG2 disease. Citation Format: Tanaka N, Ogura K, Kamimura M, Hattori A, Inoue H, Yukawa H, Sakaguchi S, Matsuoka A, Kodera A, Hirano A. Effect of adjuvant chemotherapy for patients with ER-positive/HER2-negative breast cancer assessed by the propensity score matching: Significance of nuclear grade and nodal status [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-13-07.

Utility of Computed Tomography in a Differential Diagnosis for the Patients with an Initial Diagnosis of Chronic Obstructive Pulmonary Disease Exacerbation

BackgroundThe utility of computed tomography (CT) in the differential diagnosis of patients with chronic obstructive pulmonary disease (COPD) exacerbation remains uncertain. However, due to the low cost associated with CT scan along with the impact of Koreas' health insurance system, there has been a rise in the number of CT scans in the patients with initial diagnosis of COPD exacerbations. Therefore, the utility of CT in the differential diagnosis was investigated to determine whether performing CT scans affect the clinical outcomes of the patients with an initial diagnosis of COPD exacerbation.MethodsThis study involved 202 COPD patients hospitalized with an initial diagnosis of COPD exacerbation. We evaluated the change in diagnosis or treatment after performing a CT scan, and compared the clinical outcomes of patient groups with vs. without performing CT (non-CT group vs. CT group).ResultsAfter performing CT, the diagnosis was changed for two (3.0%) while additional diagnoses were made for 27 of the 64 patients (42.1%). However, the treatment changed for only one (1.5%), and six patients (9.3%) received supplementary medication. There were no difference in the median length of hospital stay (8 [6–13] days vs. 8 [6–12] days, p=0.786) and intensive care unit care (14 [10.1%] vs. 11 [16.7%], p=0.236) between the CT and non-CT groups, respectively. These findings remained consistent even after the propensity score matching.ConclusionUtility of CT in patients with acute COPD exacerbation might not be helpful; therefore, we do not recommend chest CT scan as a routine initial diagnostic tool.

P087 Where has all the Mycoplasma gone?

Background Non gonococcal urethritis (NGU) is thought to be most often due to Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) and Ureaplasma urealyticum . Standard doses of Azithromycin 1g stat may be insufficient to clear MG and may induce resistance to macrolides while doxycycline is not sufficient to clear MG. Doxycycline has been advocated as first line therapy for NGU allowing extended dosage with Azithromycin in those that do not clear with first line therapies. Aim To look at the current pathways for managing NGU and assess how often patients who have first line Doxycycline return for further therapy. Methods A retrospective review of all patients initially treated for NGU in August and September 2015 across a sexual health trust. Results Of the 208 cases reviewed, 26.4% were due to CT. 99.5% of all cases were treated with a first line antibiotic; with 95.2% receiving Doxycycline 100mg bd for 7 days compared to 4.3% receiving Azithromycin 1g stat. In both the CT and non-CT groups 9%, returned within 90 days after experiencing symptoms despite treatment. Of these, only 15.8% were diagnosed with persistent NGU and treated with extended Azithromycin. Conclusion Current pathways designed to preserve macrolide therapy using Doxycycline initially result in few patients reattending with persistent symptoms than would be anticipated. The impact of Doxycycline on reducing MG load and related symptoms should be factored into advice given to patients who may dismiss mild symptoms or be reassured by negative CT/NG NAATs often communicated to them by text.

Influence of CT utilisation on patient flow in the emergency department: a retrospective 1-year cohort study

ObjectiveCT, an important diagnostic tool in the emergency department (ED), might increase the ED length of stay (LOS). Considering the issue of ED overcrowding, it is important to evaluate whether...

Use of External Distractors and the Role of Imaging Prior to Mandibular Distraction in Infants With Isolated Pierre Robin Sequence and Stickler Syndrome.

Computed tomographic (CT) scans are often obtained before mandibular distraction osteogenesis in patients with isolated Pierre Robin sequence. There is concern regarding the risk of radiation exposure from CT in children. To evaluate whether preoperative CT is necessary for adequate airway, feeding, and aesthetic outcomes following mandibular distraction with external distraction devices in infants with isolated Pierre Robin sequence. In a retrospective review of medical records, infants who underwent mandibular distraction between January 1, 1998, and September 30, 2014, at 2 tertiary children's hospitals were identified using procedure codes. Data analysis was conducted December 1, 2014, to March 31, 2015. Fifty-two patients fit the inclusion criteria of isolated Pierre Robin sequence or Stickler syndrome, of being younger than 9 months at the time of distraction, and of use of external distractors. Forty-two of these infants did not receive preoperative CT imaging. Mandibular distraction osteogenesis for isolated Pierre Robin sequence or Stickler syndrome. Number of infants who were able to avoid tracheostomy or achieve decannulation, who were able to avoid placement or achieve removal of a gastrostomy tube, and in whom there were no intraoperative complications, no open-bite deformity, no malocclusion, no asymmetry, and no postoperative complications. In comparison with the 10 infants who underwent preoperative CT, all 42 of the infants (100%) who did not receive preoperative CT imaging successfully avoided tracheostomy or achieved decannulation (P = .04) and 40 patients (95%) did not require placement of a gastrostomy tube or were able to undergo gastrostomy tube removal postoperatively (P < .001). There were no significant differences between the CT and non-CT groups in the other 5 outcome measures. Two patients (5%) required postoperative gastrostomy tube placement, 2 patients (5%) had minor intraoperative complications that might have been anticipated with CT, 2 patients (5%) demonstrated malocclusion, and 1 infant (2%) had asymmetry at the end of the distraction phase. This series suggests that the absence of preoperative CT does not compromise functional or aesthetic outcomes in mandibular distraction with external distraction devices in infants with isolated Pierre Robin sequence or Stickler syndrome. This finding has implications for cost containment and reduction of radiation exposure to a vulnerable population. 4.

Effect of IV Contrast Medium on Renal Function in Oncologic Patients Undergoing CT in ICU

The purpose of our study was to assess the effect of IV contrast medium administered at CT on serum creatinine in an oncologic ICU population and to determine which of the variables before CT are most associated with renal function after administration of contrast material. We retrospectively reviewed 3,848 patient admissions to an oncology ICU. The following matched comparisons were undertaken: contrast-enhanced CT versus unenhanced CT and CT (with or without contrast medium) versus no CT. Matching criteria included age, sex, baseline serum creatinine, and severity of illness (modified sequential organ failure assessment [mSOFA] score). No patients with creatinine > 2.0 mg/dL received contrast material. Groups were compared using a rank sum test. Factors influencing creatinine after administration of contrast material were evaluated by multiple regression analysis. Parallel analyses using estimated glomerular filtration rate (eGFR) also were performed. No significant difference was found in absolute change in creatinine between matched contrast-enhanced CT and unenhanced CT groups (n = 81), with mean (95% CI) creatinine rises after CT of 0.25 (0.04-0.46) and 0.11 (0.04-0.18) mg/dL, respectively. Similarly, for matched CT versus non-CT groups (n = 152), mean creatinine rises were 0.15 (0.05-0.25) and 0.12 (0.08-0.16) mg/dL, respectively. Parallel analyses using eGFR yielded similar results. Creatinine after administration of contrast material was associated with sex and mSOFA (p = 0.04 and 0.02, respectively) but not baseline creatinine. eGFR after administration of contrast material was associated with baseline eGFR (p < 0.0001). Administration of IV contrast medium in oncologic ICU patients with relatively normal creatinine is associated with an increase in creatinine but not beyond that of simply undergoing CT or of a matched non-CT group in ICU. The eGFR, which includes sex in its derivation, may be a better predictor of contrast-enhanced renal function than creatinine.

The Impact of the Liberal Use of CT in the Work Up of Acute Appendicitis

Background: Acute appendicitis has historically been considered a clinical diagnosis, necessitating a CT scan only in the face of equivocal signs and symptoms. The purpose of this study is to determine whether or not the liberal use of CT in the work up of acute appendicitis results in a decreased negative appendectomy rate (NAR). Methods: The medical records of 940 consecutive patients who underwent emergency appendectomy between January 2002 and December 2006 were reviewed. Data collected included patient demographics, length of stay (LOS), results of contrast enhanced CT scans, emergency department (ED) work up time, and final pathology. Results: During the study period 940 patients (mean age 34.5±16.7 years, 53% males) underwent emergency appendec- tomy (64% laparoscopic). Eight hundred thirteen (86% patients, 50% males) underwent pre-operative CT scans. Final pathology was 76.1% acute appendicitis, 10% acute appendicitis with perforation, 7.7% gangrenous appendicitis, 1.2% acute appendicitis with abscess, 0.7% chronic appendicitis, and 4.3% negative for appendicitis. No difference was noted in the overall appendicitis rate by gender in the CT (Fishers exact test, p=0.96) or non-CT group (Fishers exact test, p=0.75). Similarly, no difference was noted by age (CT p=0.14, non-CT p=0.26). The NAR was lower for the CT group (3.4%) compared to the non-CT group (9.4%) (p=0.002). The NAR did not differ significantly by gender (Fishers exact test, p=0.491). Despite prolonging the ED work up time by 4.3 hours, the perforation rate did not differ between the CT (9.5%) and non-CT (12.6%) groups (p=0.30), nor did the LOS (3.67 vs. 3.63 days, p= 0.92). The sensitivity, specificity, negative predictive value, and positive predictive value of CT scans was 99%, 61%, 68%, and 99%, with an overall accu- racy of 98%. The positive and negative likelihood ratios were 2.52 and 0.02 respectively. The ROC for CT scans in pre- dicting appendicitis was 79.8% (95% CI: 76.9%, 82.5%). Conclusions: The use of CT in the work up of acute appendicitis is associated with a lower negative appendectomy rate independent of gender and age. The additional time spent obtaining a CT does not appear to increase the risk of perfora- tion nor increase the LOS.