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Modified Brixia chest X-ray severity scoring system and correlation with intubation, non-invasive ventilation and death in a hospitalised COVID-19 cohort
Hanley, Marion; Brosnan, Conor; O'Neill, Damien; Ni Mhuircheartaigh, Neasa; Logan, Mark; Morrin, Martina M; Hurley, Killian; Sulaiman, Imran; O'Brien, Emmet; Morgan, Ross; Lee, Michael J
INTRODUCTION/BACKGROUND:There are few existing severity scoring systems in the literature, and no formally widely accepted chest X-ray template for reporting COVID-19 infection. We aimed to modify the chest X-ray COVID-19 severity scoring system from the Brixia scoring system with placement of more emphasis on consolidation and to assess if the scoring tool could help predict intubation. METHODS:A severity chest X-ray scoring system was modified from the Brixia scoring system. PCR positive COVID-19 positive patient's chest X-rays admitted to our hospital over 3 months were reviewed and correlated with; non-invasive ventilation, intubation and death. An analysis was performed using a receiver operating curve to predict intubation from all admission chest X-rays. RESULTS:The median score of all 325 admission chest X-rays was 3 (Interquartile range (IQR) 0-6.5). The median score of admission chest X-rays of those who did not require ICU admission and survived was 1.5 (IQR 0-5); and 9 (IQR 4.75-12) was median admission score of those requiring intubation. The median scores of the pre-intubation ICU chest X-rays was 11.5 (IQR 9-14.125), this increased from a median admission chest X-ray score for this group of 9 (P-value < 0.01). A cut-off score of 6 had a sensitivity of 77% and specificity of 73% in predicting the need for intubation. CONCLUSION/CONCLUSIONS:Higher chest X-ray severity scores are associated with intubation, need for non-invasive ventilation and death. This tool may also be helpful in predicting intubation.
PMID: 34845851
ISSN: 1754-9485
CID: 5087052
Physician wellness in orthopaedic surgery : a multinational survey study
Mir, Hassan; Downes, Katheryne; Chen, Antonia F; Grewal, Ruby; Kelly, Derek M; Lee, Michael J; Leucht, Philipp; Dulai, Sukhdeep K
AIMS/OBJECTIVE:Physician burnout and its consequences have been recognized as increasingly prevalent and important issues for both organizations and individuals involved in healthcare delivery. The purpose of this study was to describe and compare the patterns of self-reported wellness in orthopaedic surgeons and trainees from multiple nations with varying health systems. METHODS:A cross-sectional survey of 774 orthopaedic surgeons and trainees in five countries (Australia, Canada, New Zealand, UK, and USA) was conducted in 2019. Respondents were asked to complete the Mayo Clinic Well-Being Index and the Stanford Professional Fulfillment Index in addition to 31 personal/demographic questions and 27 employment-related questions via an anonymous online survey. RESULTS:A total of 684 participants from five countries (Australia (n = 74), Canada (n = 90), New Zealand (n = 69), UK (n = 105), and USA (n = 346)) completed both of the risk assessment questionnaires (Mayo and Stanford). Of these, 42.8% (n = 293) were trainees and 57.2% (n = 391) were attending surgeons. On the Mayo Clinic Well-Being Index, 58.6% of the overall sample reported feeling burned out (n = 401). Significant differences were found between nations with regards to the proportion categorized as being at risk for poor outcomes (27.5% for New Zealand (19/69) vs 54.4% for Canada (49/90) ; p = 0.001). On the Stanford Professional Fulfillment Index, 38.9% of the respondents were classified as being burned out (266/684). Prevalence of burnout ranged from 27% for Australia (20/74 up to 47.8% for Canadian respondents (43/90; p = 0.010). Younger age groups (20 to 29: RR 2.52 (95% confidence interval (CI) 1.39 to 4.58; p = 0.002); 30 to 39: RR 2.40 (95% CI 1.36 to 4.24; p = 0.003); 40 to 49: RR 2.30 (95% CI 1.35 to 3.9; p = 0.002)) and trainee status (RR 1.53 (95% CI 1.15 to 2.03 p = 0.004)) were independently associated with increased relative risk of having a 'at-risk' or 'burnout' score. CONCLUSIONS:Â 2021;2(11):932-939.
PMID: 34766825
ISSN: 2633-1462
CID: 5050792
Evaluation of the LI-RADS treatment response algorithm in hepatocellular carcinoma after trans-arterial chemoembolization
Kierans, Andrea S; Najjar, Marc; Dutruel, Silvina P; Gavlin, Alexander; Chen, Christine; Lee, Michael J; Askin, Gulce; Halazun, Karim J
PURPOSE/OBJECTIVE:To evaluate the diagnostic performance of LI-RADS treatment response algorithm (LR-TRA) and modified RECIST (mRECIST) for the detection of viable hepatocellular carcinoma (HCC) on MRI after trans-arterial chemoembolization (TACE). MATERIALS AND METHODS/METHODS:This retrospective study includes cirrhotic patients that underwent trans-arterial chemoembolization prior to liver transplantation from 2013 to 2017 with a pre- and post-treatment MRI available. Three blinded readers assigned a LR-TRA and mRECIST category to each lesion. Lesions on MRI and explant pathology were matched and characterized as complete (100% necrosis) or incomplete necrosis (≤99% necrosis). Diagnostic performance of LR-TRA and mRECIST were calculated with a generalized estimating equation. RESULTS:A total of 52 patients with 71 lesions were included, 47 with incomplete and 24 with complete necrosis. In consensus, 45 lesions were categorized as LR-TR Nonviable, of which 62.2% (28/45) had incomplete and 37.8% (17/45) had complete necrosis. Six lesions were categorized as LR-TR Equivocal, of which 33.3% (2/6) had incomplete and 66.7% (4/6) had complete necrosis. Twenty lesions were categorized as LR-TR Viable of which 85.0% (17/20) had incomplete and 15.0% (3/20) had complete necrosis. The sensitivity of LR-TR Viable for detecting incompletely necrotic tumor when LR-TR Equivocal was considered as viable, in consensus was 40.4%; specificity 70.8%; accuracy 50.7%. The sensitivity of mRECIST for detecting incompletely necrotic tumor was 37.0%; specificity 79.2%; accuracy 51.4%. There was no significant difference in diagnostic performance between mRECIST and LR-TRA (p = 0.14-0.33). Agreement for LR-TRA category was moderate (k = 0.53 [95% CI: 0.45, 0.67]). CONCLUSION/CONCLUSIONS:LI-RADS treatment response algorithm demonstrates high specificity and low to moderate sensitivity for the detection of viable HCC after TACE in a North American cirrhotic cohort, without significant difference in diagnostic performance between LR-TRA and mRECIST.
PMID: 34303189
ISSN: 1873-4499
CID: 4948882
The Influence of Selective Serotonin Reuptake Inhibitors on Lumbar Arthrodesis
Pirkle, Sean; Bhattacharjee, Sarah; El Dafrawy, Mostafa; Leucht, Philipp; Shi, Lewis L; Lee, Michael J
STUDY DESIGN/METHODS:Retrospective analysis using the PearlDiver national insurance claims database. OBJECTIVE:To investigate the relationship between chronic preoperative selective serotonin reuptake inhibitor (SSRI) prescriptions and nonunion following spine fusion surgery. SUMMARY OF BACKGROUND DATA/BACKGROUND:Contemporary literature has linked SSRIs to decreased bone mineral density and increased rates of future bone fracture. Furthermore, a recent murine model has suggested a potential role in the quality of fracture healing itself. METHODS:All single-level lumbar fusion patients were identified. The rate of nonunion diagnosis between 6 and 24 months following surgery was assessed. A stratified analysis of chronic SSRI use and a number of comorbidities was conducted, followed by a multiple logistic regression analysis of nonunion accounting for qualifying risk factors. Finally, subanalyses of individual procedure codes were carried out. RESULTS:In total, 7905 single-level lumbar fusion patients were included. In the multivariate analysis, chronic SSRI [odds ratio (OR): 1.558, P=0.004] and tobacco use (OR: 1.500, P=0.011) were identified as independent risk factors for nonunion, whereas patient age over 60 years (OR: 0.468, P<0.001) was observed to be negatively associated with nonunion. In the individual procedure subanalyses, SSRIs were significantly associated with nonunion in 2 of 3 univariate analyses and observed to be an independent risk factor for nonunion in 2 of the 3 procedure populations. CONCLUSIONS:These data suggest that patients treated concomitantly for mental health disorders with SSRIs before arthrodesis may be at an increased risk of postoperative nonunion. Closer follow-up may be indicated in this patient population.
PMID: 32991364
ISSN: 2380-0194
CID: 4616722
COVID-19 Associated Hepatitis Complicating Recent Living Donor Liver Transplantation
Lagana, Stephen M; De Michele, Simona; Lee, Michael J; Emond, Jean C; Griesemer, Adam D; Tulin-Silver, Sheryl A; Verna, Elizabeth C; Martinez, Mercedes; Lefkowitch, Jay H
We present a case of COVID-19 hepatitis in a living donor liver allograft recipient whose donor subsequently tested positive for COVID-19. The patient is a female infant with biliary atresia (failed Kasai procedure). She recovered well, with improving liver function tests for 4 days. On post-operative day (POD) 4 the patient developed respiratory distress and fever. COVID-19 testing (polymerase chain reaction) was positive. Liver function tests increased approximately 5-fold. Liver biopsy showed moderate acute hepatitis with prominent clusters of apoptotic hepatocytes and associated cellular debris. Lobular lymphohistiocytic inflammation was noted. Typical portal features of mild to moderate acute cellular rejection were also noted.
PMID: 32302212
ISSN: 1543-2165
CID: 4383892
Overall Health, Daily Functioning, and Quality of Life in Acute Hepatic Porphyria Patients: ENVISION, a Phase 3 Global, Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial [Meeting Abstract]
Sardh, E; Gouya, L; Rees, D C; Stein, P; Stolzel, U; Aguilera, Peiro P; Bissell, D M; Bonkovsky, H L; Keel, S; Parker, C; Phillips, J D; Silver, S; Windyga, J; D'Avola, D; Ross, G; Stewart, P; Ritchie, B; Oh, J; Harper, P; Wang, J D; Langendonk, J G; Ivanova, A; Horie, Y; Anderson, K E; Ventura, P; Kauppinen, R; Vassiliou, D; Wang, B; Hother-Nielsen, O; Nakahara, T; Lee, M J; Sasapu, A; Scalera, S; Lin, T; Penz, C; Simon, A; Ko, J; Balwani, M
Objectives: Acute Hepatic Porphyria (AHP) is a family of rare genetic diseases leading to an enzyme deficiency in the heme biosynthesis pathway, causing accumulation of neurotoxic heme intermediates, resulting in neurovisceral attacks and chronic manifestations. Givosiran, an investigational RNAi therapeutic, is being evaluated for its ability to reduce the levels of neurotoxic intermediates thus decreasing attacks and disease manifestations.
Aim(s): ENVISION (NCT03338816), a Phase 3 global, multicenter, randomized, double-blind, placebo-controlled trial, evaluated the efficacy and safety of givosiran in AHP.
Method(s): The primary endpoint was composite annualized attacks over six months. Secondary endpoints included worst daily pain, and the QoL Physical Component Summary, Short Form-12 (PCS SF-12). Exploratory endpoints included EuroQoL Visual analog scale (EQ-VAS), Patient Global Impression of Change (PGIC), Porphyria Patient Experience Questionnaire (PPEQ), and missed days of work.
Result(s): Ninety-four AHP patients enrolled. Givosiran significantly reduced composite attacks relative to placebo (p = 6.04x10-9), as well as the cardinal symptom of pain (p = 0.0493). Givosiran led to greater change in PCS SF-12 scores from baseline (givosiran = 5.4; placebo = 1.4, p = 0.0216), and to higher change in EQ-VAS scores (givosiran = 5.2; placebo = -1.3). More givosiran patients (89 %) reported greater improvements in overall health since study-start, as measured by PGIC, than placebo (37 %). Givosiran led to greater improvement in PPEQ (traveling, social activities, planning future events, household chores, exercise, and treatment satisfaction) and fewer missed work days, compared to placebo.
Conclusion(s): In a Phase 3 study, givosiran treatment resulted in clinically meaningful efficacy and marked improvements in AHP patients' overall health status, daily functioning, and quality of life.
Copyright
EMBASE:2004787667
ISSN: 1590-8658
CID: 4327492
eTICI reperfusion: defining success in endovascular stroke therapy
Liebeskind, David S; Bracard, Serge; Guillemin, Francis; Jahan, Reza; Jovin, Tudor G; Majoie, Charles Blm; Mitchell, Peter J; van der Lugt, Aad; Menon, Bijoy K; San Román, Luis; Campbell, Bruce Cv; Muir, Keith W; Hill, Michael D; Dippel, Diederik Wj; Saver, Jeffrey L; Demchuk, Andrew M; Dávalos, Antoni; White, Philip; Brown, Scott; Goyal, Mayank; Berkhemer, O A; Fransen, P S; Beumer, D; van den Berg, L A; Lingsma, H F; Yoo, A J; Schonewille, W J; Vos, J A; Nederkoorn, P J; Wermer, M J; van Walderveen, M A; Staals, J; Hofmeijer, J; van Oostayen, J A; Lycklama À Nijeholt, G J; Boiten, J; Brouwer, P A; Emmer, B J; de Bruijn, S F; van Dijk, L C; Kappelle, J; Lo, R H; van Dijk, E J; de Vries, J; de Kort, Plm; van Rooij, Wjj; van den Berg, Jsp; van Hasselt, Baam; Aerden, Lam; Dallinga, R J; Visser, M C; Bot, Jcj; Vroomen, P C; Eshghi, O; Schreuder, Thcml; Heijboer, Rjj; Keizer, K; Tielbeek, A V; den Hertog, H M; Gerrits, D G; van den Berg-Vos, R M; Karas, G B; Steyerberg, E W; Flach, Z; Marquering, H A; Sprengers, Mes; Jenniskens, Sfm; Beenen, Lfm; van den Berg, R; Koudstaal, P J; van Zwam, W H; Roos, Ybwem; van der Lugt, A; van Oostenbrugge, R J; Majoie, Cblm; Dippel, Dwj; Brown, M M; Liebig, T; Stijnen, T; Andersson, T; Mattle, H; Wahlgren, N; van der Heijden, E; Ghannouti, N; Fleitour, N; Hooijenga, I; Puppels, C; Pellikaan, W; Geerling, A; Lindl-Velema, A; van Vemde, G; de Ridder, A; Greebe, P; de Bont-Stikkelbroeck, J; de Meris, J; Janssen, K; Struijk, W; Licher, S; Boodt, N; Ros, A; Venema, E; Slokkers, I; Ganpat, R J; Mulder, M; Saiedie, N; Heshmatollah, A; Schipperen, S; Vinken, S; van Boxtel, T; Koets, J; Boers, M; Santos, E; Borst, J; Jansen, I; Kappelhof, M; Lucas, M; Geuskens, R; Barros, R S; Dobbe, R; Csizmadia, M; Hill, M D; Goyal, M; Demchuk, A M; Menon, B K; Eesa, M; Ryckborst, K J; Wright, M R; Kamal, N R; Andersen, L; Randhawa, P A; Stewart, T; Patil, S; Minhas, P; Almekhlafi, M; Mishra, S; Clement, F; Sajobi, T; Shuaib, A; Montanera, W J; Roy, D; Silver, F L; Jovin, T G; Frei, D F; Sapkota, B; Rempel, J L; Thornton, J; Williams, D; Tampieri, D; Poppe, A Y; Dowlatshahi, D; Wong, J H; Mitha, A P; Subramaniam, S; Hull, G; Lowerison, M W; Sajobi, T; Salluzzi, M; Wright, M R; Maxwell, M; Lacusta, S; Drupals, E; Armitage, K; Barber, P A; Smith, E E; Morrish, W F; Coutts, S B; Derdeyn, C; Demaerschalk, B; Yavagal, D; Martin, R; Brant, R; Yu, Y; Willinsky, R A; Montanera, W J; Weill, A; Kenney, C; Aram, H; Stewart, T; Stys, P K; Watson, T W; Klein, G; Pearson, D; Couillard, P; Trivedi, A; Singh, D; Klourfeld, E; Imoukhuede, O; Nikneshan, D; Blayney, S; Reddy, R; Choi, P; Horton, M; Musuka, T; Dubuc, V; Field, T S; Desai, J; Adatia, S; Alseraya, A; Nambiar, V; van Dijk, R; Wong, J H; Mitha, A P; Morrish, W F; Eesa, M; Newcommon, N J; Shuaib, A; Schwindt, B; Butcher, K S; Jeerakathil, T; Buck, B; Khan, K; Naik, S S; Emery, D J; Owen, R J; Kotylak, T B; Ashforth, R A; Yeo, T A; McNally, D; Siddiqui, M; Saqqur, M; Hussain, D; Kalashyan, H; Manosalva, A; Kate, M; Gioia, L; Hasan, S; Mohammad, A; Muratoglu, M; Williams, D; Thornton, J; Cullen, A; Brennan, P; O'Hare, A; Looby, S; Hyland, D; Duff, S; McCusker, M; Hallinan, B; Lee, S; McCormack, J; Moore, A; O'Connor, M; Donegan, C; Brewer, L; Martin, A; Murphy, S; O'Rourke, K; Smyth, S; Kelly, P; Lynch, T; Daly, T; O'Brien, P; O'Driscoll, A; Martin, M; Daly, T; Collins, R; Coughlan, T; McCabe, D; Murphy, S; O'Neill, D; Mulroy, M; Lynch, O; Walsh, T; O'Donnell, M; Galvin, T; Harbison, J; McElwaine, P; Mulpeter, K; McLoughlin, C; Reardon, M; Harkin, E; Dolan, E; Watts, M; Cunningham, N; Fallon, C; Gallagher, S; Cotter, P; Crowe, M; Doyle, R; Noone, I; Lapierre, M; Coté, V A; Lanthier, S; Odier, C; Durocher, A; Raymond, J; Weill, A; Daneault, N; Deschaintre, Y; Jankowitz, B; Baxendell, L; Massaro, L; Jackson-Graves, C; Decesare, S; Porter, P; Armbruster, K; Adams, A; Billigan, J; Oakley, J; Ducruet, A; Jadhav, A; Giurgiutiu, D V; Aghaebrahim, A; Reddy, V; Hammer, M; Starr, M; Totoraitis, V; Wechsler, L; Streib, S; Rangaraju, S; Campbell, D; Rocha, M; Gulati, D; Silver, F L; Krings, T; Kalman, L; Cayley, A; Williams, J; Stewart, T; Wiegner, R; Casaubon, L K; Jaigobin, C; Del Campo, J M; Elamin, E; Schaafsma, J D; Willinsky, R A; Agid, R; Farb, R; Ter Brugge, K; Sapkoda, B L; Baxter, B W; Barton, K; Knox, A; Porter, A; Sirelkhatim, A; Devlin, T; Dellinger, C; Pitiyanuvath, N; Patterson, J; Nichols, J; Quarfordt, S; Calvert, J; Hawk, H; Fanale, C; Frei, D F; Bitner, A; Novak, A; Huddle, D; Bellon, R; Loy, D; Wagner, J; Chang, I; Lampe, E; Spencer, B; Pratt, R; Bartt, R; Shine, S; Dooley, G; Nguyen, T; Whaley, M; McCarthy, K; Teitelbaum, J; Tampieri, D; Poon, W; Campbell, N; Cortes, M; Dowlatshahi, D; Lum, C; Shamloul, R; Robert, S; Stotts, G; Shamy, M; Steffenhagen, N; Blacquiere, D; Hogan, M; AlHazzaa, M; Basir, G; Lesiuk, H; Iancu, D; Santos, M; Choe, H; Weisman, D C; Jonczak, K; Blue-Schaller, A; Shah, Q; MacKenzie, L; Klein, B; Kulandaivel, K; Kozak, O; Gzesh, D J; Harris, L J; Khoury, J S; Mandzia, J; Pelz, D; Crann, S; Fleming, L; Hesser, K; Beauchamp, B; Amato-Marzialli, B; Boulton, M; Lopez-Ojeda, P; Sharma, M; Lownie, S; Chan, R; Swartz, R; Howard, P; Golob, D; Gladstone, D; Boyle, K; Boulos, M; Hopyan, J; Yang, V; Da Costa, L; Holmstedt, C A; Turk, A S; Navarro, R; Jauch, E; Ozark, S; Turner, R; Phillips, S; Shankar, J; Jarrett, J; Gubitz, G; Maloney, W; Vandorpe, R; Schmidt, M; Heidenreich, J; Hunter, G; Kelly, M; Whelan, R; Peeling, L; Burns, P A; Hunter, A; Wiggam, I; Kerr, E; Watt, M; Fulton, A; Gordon, P; Rennie, I; Flynn, P; Smyth, G; O'Leary, S; Gentile, N; Linares, G; McNelis, P; Erkmen, K; Katz, P; Azizi, A; Weaver, M; Jungreis, C; Faro, S; Shah, P; Reimer, H; Kalugdan, V; Saposnik, G; Bharatha, A; Li, Y; Kostyrko, P; Santos, M; Marotta, T; Montanera, W; Sarma, D; Selchen, D; Spears, J; Heo, J H; Jeong, K; Kim, D J; Kim, B M; Kim, Y D; Song, D; Lee, K J; Yoo, J; Bang, O Y; Rho, S; Lee, J; Jeon, P; Kim, K H; Cha, J; Kim, S J; Ryoo, S; Lee, M J; Sohn, S I; Kim, C H; Ryu, H G; Hong, J H; Chang, H W; Lee, C Y; Rha, J; Davis, S M; Donnan, G A; Campbell, B C; Mitchell, P J; Churilov, L; Yan, B; Dowling, R; Yassi, N; Oxley, T J; Wu, T Y; Silver, G; McDonald, A; McCoy, R; Kleinig, T J; Scroop, R; Dewey, H M; Simpson, M; Brooks, M; Coulton, B; Krause, M; Harrington, T J; Steinfort, B; Faulder, K; Priglinger, M; Day, S; Phan, T; Chong, W; Holt, M; Chandra, R V; Ma, H; Young, D; Wong, K; Wijeratne, T; Tu, H; Mackay, E; Celestino, S; Bladin, C F; Loh, P S; Gilligan, A; Ross, Z; Coote, S; Frost, T; Parsons, M W; Miteff, F; Levi, C R; Ang, T; Spratt, N; Kaauwai, L; Badve, M; Rice, H; de Villiers, L; Barber, P A; McGuinness, B; Hope, A; Moriarty, M; Bennett, P; Wong, A; Coulthard, A; Lee, A; Jannes, J; Field, D; Sharma, G; Salinas, S; Cowley, E; Snow, B; Kolbe, J; Stark, R; King, J; Macdonnell, R; Attia, J; D'Este, C; Saver, J L; Goyal, M; Diener, H C; Levy, E I; Bonafé, A; Mendes Pereira, V; Jahan, R; Albers, G W; Cognard, C; Cohen, D J; Hacke, W; Jansen, O; Jovin, T G; Mattle, H P; Nogueira, R G; Siddiqui, A H; Yavagal, D R; von Kummer, R; Smith, W; Turjman, F; Hamilton, S; Chiacchierini, R; Amar, A; Sanossian, N; Loh, Y; Devlin, T; Baxter, B; Hawk, H; Sapkota, B; Quarfordt, S; Sirelkhatim, A; Dellinger, C; Barton, K; Reddy, V K; Ducruet, A; Jadhav, A; Horev, A; Giurgiutiu, D V; Totoraitis, V; Hammer, M; Jankowitz, B; Wechsler, L; Rocha, M; Gulati, D; Campbell, D; Star, M; Baxendell, L; Oakley, J; Siddiqui, A; Hopkins, L N; Snyder, K; Sawyer, R; Hall, S; Costalat, V; Riquelme, C; Machi, P; Omer, E; Arquizan, C; Mourand, I; Charif, M; Ayrignac, X; Menjot de Champfleur, N; Leboucq, N; Gascou, G; Moynier, M; du Mesnil de Rochemont, R; Singer, O; Berkefeld, J; Foerch, C; Lorenz, M; Pfeilschifer, W; Hattingen, E; Wagner, M; You, S J; Lescher, S; Braun, H; Dehkharghani, S; Belagaje, S R; Anderson, A; Lima, A; Obideen, M; Haussen, D; Dharia, R; Frankel, M; Patel, V; Owada, K; Saad, A; Amerson, L; Horn, C; Doppelheuer, S; Schindler, K; Lopes, D K; Chen, M; Moftakhar, R; Anton, C; Smreczak, M; Carpenter, J S; Boo, S; Rai, A; Roberts, T; Tarabishy, A; Gutmann, L; Brooks, C; Brick, J; Domico, J; Reimann, G; Hinrichs, K; Becker, M; Heiss, E; Selle, C; Witteler, A; Al-Boutros, S; Danch, M J; Ranft, A; Rohde, S; Burg, K; Weimar, C; Zegarac, V; Hartmann, C; Schlamann, M; Göricke, S; Ringlestein, A; Wanke, I; Mönninghoff, C; Dietzold, M; Budzik, R; Davis, T; Eubank, G; Hicks, W J; Pema, P; Vora, N; Mejilla, J; Taylor, M; Clark, W; Rontal, A; Fields, J; Peterson, B; Nesbit, G; Lutsep, H; Bozorgchami, H; Priest, R; Ologuntoye, O; Barnwell, S; Dogan, A; Herrick, K; Takahasi, C; Beadell, N; Brown, B; Jamieson, S; Hussain, M S; Russman, A; Hui, F; Wisco, D; Uchino, K; Khawaja, Z; Katzan, I; Toth, G; Cheng-Ching, E; Bain, M; Man, S; Farrag, A; George, P; John, S; Shankar, L; Drofa, A; Dahlgren, R; Bauer, A; Itreat, A; Taqui, A; Cerejo, R; Richmond, A; Ringleb, P; Bendszus, M; Möhlenbruch, M; Reiff, T; Amiri, H; Purrucker, J; Herweh, C; Pham, M; Menn, O; Ludwig, I; Acosta, I; Villar, C; Morgan, W; Sombutmai, C; Hellinger, F; Allen, E; Bellew, M; Gandhi, R; Bonwit, E; Aly, J; Ecker, R D; Seder, D; Morris, J; Skaletsky, M; Belden, J; Baker, C; Connolly, L S; Papanagiotou, P; Roth, C; Kastrup, A; Politi, M; Brunner, F; Alexandrou, M; Merdivan, H; Ramsey, C; Given Ii, C; Renfrow, S; Deshmukh, V; Sasadeusz, K; Vincent, F; Thiesing, J T; Putnam, J; Bhatt, A; Kansara, A; Caceves, D; Lowenkopf, T; Yanase, L; Zurasky, J; Dancer, S; Freeman, B; Scheibe-Mirek, T; Robison, J; Rontal, A; Roll, J; Clark, D; Rodriguez, M; Fitzsimmons, B F; Zaidat, O; Lynch, J R; Lazzaro, M; Larson, T; Padmore, L; Das, E; Farrow-Schmidt, A; Hassan, A; Tekle, W; Cate, C; Jansen, O; Cnyrim, C; Wodarg, F; Wiese, C; Binder, A; Riedel, C; Rohr, A; Lang, N; Laufs, H; Krieter, S; Remonda, L; Diepers, M; Añon, J; Nedeltchev, K; Kahles, T; Biethahn, S; Lindner, M; Chang, V; Gächter, C; Esperon, C; Guglielmetti, M; Arenillas Lara, J F; Martínez Galdámez, M; Calleja Sanz, A I; Cortijo Garcia, E; 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BACKGROUND:Revascularization after endovascular therapy for acute ischemic stroke is measured by the Thrombolysis In Cerebral Infarction (TICI) scale, yet variability exists in scale definitions. We examined the degree of reperfusion with the expanded TICI (eTICI) scale and association with outcomes in the HERMES collaboration of recent endovascular trials. METHODS:The HERMES Imaging Core, blind to all other data, evaluated angiography after endovascular therapy in HERMES. A battery of TICI scores (mTICI, TICI, TICI2C) was used to define reperfusion of the initial target occlusion defined by non-invasive imaging and conventional angiography. RESULTS:Angiography of 801 subjects was available, including 797 defined by non-invasive imaging (154 internal carotid artery (ICA), 583 M1, 60 M2) and 748 by conventional angiography (195 ICA, 459 M1, 94 M2). Among 729 subjects in whom the reperfusion grade could be established, using eTICI (3=100%, 2C=90-99%, 2b67=67-89%, 2b50=50-66%) of the conventional angiography target occlusion, there were 63 eTICI 3 (9%), 166 eTICI 2c (23%), 218 eTICI 2b67 (30%), 103 eTICI 2b50 (14%), 100 eTICI 2a (14%), 19 eTICI 1 (3%), and 60 eTICI 0 (8%). Modified Rankin Scale shift analyses from baseline to 90 days showed that increasing TICI grades were linked with better outcomes, with significant distinctions between TICI 0/1 versus 2a (p=0.028), 2a versus 2b50 (p=0.017), and 2b50 versus 2b67 (p=0.014). CONCLUSIONS:The benefit of endovascular therapy in HERMES was strongly associated with increasing degrees of reperfusion defined by eTICI. The eTICI metric identified meaningful distinctions in clinical outcomes and may be used in future studies and routine practice.
PMID: 30194109
ISSN: 1759-8486
CID: 5121952
Real-World Effectiveness of Physical Therapy for Common Neck Pain Diagnoses: A Multivariate Analysis of 1554 Patients
Divi, Srikanth N; Eleswarapu, Ananth S; Stout, Christopher E; Lee, Michael J
STUDY DESIGN:Retrospective cohort study (Level of evidence-3). OBJECTIVE:The objective of this study was to investigate the real-life effectiveness of physical therapy (PT) for patients initially presenting with common neck pain diagnoses. SUMMARY OF BACKGROUND DATA:Neck pain is a common cause of morbidity and a leading cause of disability in the United States. PT is prescribed as a first-line treatment for the vast majority of patients with neck pain; however, there is limited literature supporting the effectiveness of these treatments. METHODS:A total of 1554 patients enrolled in PT for the nonoperative treatment of neck pain were included in the study. Three primary patient-reported outcome (PRO) measures [neck disability index (NDI), resting numeric pain rating scale (NPRS), and activity NPRS] were recorded before and at conclusion of therapy. Improvement was noted if patients met a threshold value for a minimal clinically important difference (MCID). Bivariate analysis using a χ test and multiple logistic regression analysis were performed to determine risk factors predictive of treatment failure. RESULTS:About 40.5% of patients achieved MCID for NDI with an average change of -6.31 points. For resting NPRS and activity NPRS scores, 50.6% and 52.1% of patients achieved MCID with an average change of -1.93 and -2.36, respectively. After multiple logistic regression analysis, worker's compensation status was found to be an independent predictor for treatment failure in all groups; whereas, Medicare status was found predictive of achieving MCID in the activity NPRS group. CONCLUSIONS:We observed that up to half of the patients analyzed met the minimum criteria for improvement in neck pain with respect to the PRO measures, suggesting that real-life effectiveness of PT for common neck pain diagnoses may approach 50%.
PMID: 30015651
ISSN: 2380-0194
CID: 4205042
Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data
Román, Luis San; Menon, Bijoy K; Blasco, Jordi; Hernández-Pérez, María; Dávalos, Antoni; Majoie, Charles B L M; Campbell, Bruce C V; Guillemin, Francis; Lingsma, Hester; Anxionnat, René; Epstein, Jonathan; Saver, Jeffrey L; Marquering, Henk; Wong, John H; Lopes, Demetrius; Reimann, Gernot; Desal, Hubert; Dippel, Diederik W J; Coutts, Shelagh; du Mesnil de Rochemont, Richard; Yavagal, Dileep; Ferre, Jean Christophe; Roos, Yvo B W E M; Liebeskind, David S; Lenthall, Robert; Molina, Carlos; Al Ajlan, Fahad S; Reddy, Vivek; Dowlatshahi, Dar; Sourour, Nader-Antoine; Oppenheim, Catherine; Mitha, Alim P; Davis, Stephen M; Weimar, Christian; van Oostenbrugge, Robert J; Cobo, Erik; Kleinig, Timothy J; Donnan, Geoffrey A; van der Lugt, Aad; Demchuk, Andrew M; Berkhemer, Olvert A; Boers, Anna M M; Ford, Gary A; Muir, Keith W; Brown, B Scott; Jovin, Tudor; van Zwam, Wim H; Mitchell, Peter J; Hill, Michael D; White, Phil; Bracard, Serge; Goyal, Mayank; Berkhemer, Olvert A; Fransen, Puck Ss; Beumer, Debbie; van den Berg, Lucie A; Lingsma, Hester F; Yoo, Albert J; Schonewille, Wouter J; Vos, Jan Albert; Nederkoorn, Paul J; Wermer, Marieke Jh; van Walderveen, Marianne Aa; Staals, Julie; Hofmeijer, Jeannette; van Oostayen, Jacques A; Lycklama À Nijeholt, Geert J; Boiten, Jelis; Brouwer, Patrick A; Emmer, Bart J; de Bruijn, Sebastiaan F; van Dijk, Lukas C; Kappelle, Jaap; Lo, Rob H; van Dijk, Ewoud J; de Vries, Joost; de Kort, Paul L M; van Rooij, Willem Jan J; van den Berg, Jan S P; van Hasselt, Boudewijn A A M; Aerden, Leo A M; Dallinga, René J; Visser, Marieke C; Bot, Joseph C J; Vroomen, Patrick C; Eshghi, Omid; Schreuder, Tobien H C M L; Heijboer, Roel J J; Keizer, Koos; Tielbeek, Alexander V; den Hertog, Heleen M; Gerrits, Dick G; van den Berg-Vos, Renske M; Karas, Giorgos B; Steyerberg, Ewout W; Flach, Zwenneke; Marquering, Henk A; Sprengers, Marieke E S; Jenniskens, Sjoerd F M; Beenen, Ludo F M; van den Berg, René; Koudstaal, Peter J; van Zwam, Wim H; Roos, Yvo B W E M; van der Lugt, Aad; 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BACKGROUND:Evidence regarding whether imaging can be used effectively to select patients for endovascular thrombectomy (EVT) is scarce. We aimed to investigate the association between baseline imaging features and safety and efficacy of EVT in acute ischaemic stroke caused by anterior large-vessel occlusion. METHODS:In this meta-analysis of individual patient-level data, the HERMES collaboration identified in PubMed seven randomised trials in endovascular stroke that compared EVT with standard medical therapy, published between Jan 1, 2010, and Oct 31, 2017. Only trials that required vessel imaging to identify patients with proximal anterior circulation ischaemic stroke and that used predominantly stent retrievers or second-generation neurothrombectomy devices in the EVT group were included. Risk of bias was assessed with the Cochrane handbook methodology. Central investigators, masked to clinical information other than stroke side, categorised baseline imaging features of ischaemic change with the Alberta Stroke Program Early CT Score (ASPECTS) or according to involvement of more than 33% of middle cerebral artery territory, and by thrombus volume, hyperdensity, and collateral status. The primary endpoint was neurological functional disability scored on the modified Rankin Scale (mRS) score at 90 days after randomisation. Safety outcomes included symptomatic intracranial haemorrhage, parenchymal haematoma type 2 within 5 days of randomisation, and mortality within 90 days. For the primary analysis, we used mixed-methods ordinal logistic regression adjusted for age, sex, National Institutes of Health Stroke Scale score at admission, intravenous alteplase, and time from onset to randomisation, and we used interaction terms to test whether imaging categorisation at baseline modifies the association between treatment and outcome. This meta-analysis was prospectively designed by the HERMES executive committee but has not been registered. FINDINGS:=0·012). INTERPRETATION:EVT achieves better outcomes at 90 days than standard medical therapy across a broad range of baseline imaging categories, including infarcts affecting more than 33% of middle cerebral artery territory or ASPECTS less than 6, although in these patients the risk of symptomatic intracranial haemorrhage was higher in the EVT group than the control group. This analysis provides preliminary evidence for potential use of EVT in patients with large infarcts at baseline. FUNDING:Medtronic.
PMID: 30264728
ISSN: 1474-4465
CID: 5121962
How Effective is Physical Therapy for Common Low Back Pain Diagnoses?: A Multivariate Analysis of 4597 Patients
Eleswarapu, Ananth S; Divi, Srikanth N; Dirschl, Douglas R; Mok, James M; Stout, Christopher; Lee, Michael J
STUDY DESIGN/METHODS:A retrospective review. OBJECTIVE:The aim of this study is to evaluate whether the treatment of low back pain with physical therapy results in clinically significant improvements in patient-reported pain and functional outcomes. SUMMARY OF BACKGROUND DATA/BACKGROUND:Low back pain is a major cause of morbidity and disability in health care. Previous studies have found poor efficacy for surgery in the absence of specific indications. A variety of nonoperative treatments are available; however, there is scant evidence to guide the practitioner as to the efficacy of these treatments. METHODS:Four thousand five hundred ninety-seven patients who underwent physical therapy for the nonoperative treatment of low back pain were included. The primary outcome measures were pre-and post-treatment scores on the Oswestry Disability Index (ODI), Numeric Pain Rating Scale (NPRS) during activity, and NPRS during rest. Previously published thresholds for minimal clinically important difference (MCID) were used to determine the proportion of patients meeting MCID for each of our outcomes. Patients with starting values below the MCID for each variable were excluded from analysis. Logistic regression analysis was used to determine patient risk factors predictive of treatment failure. RESULTS:About 28.5% of patients met the MCID for improvement in ODI. Presence of night symptoms, obesity, and smoking were predictors of treatment failure for ODI. Fifty-nine percent of patients met the MCID for improvement in resting NPRS, with a history of venous thromboembolism, night symptoms, psychiatric disease, workers' compensation status, smoking, and obesity predictive of treatment failure. Sixty percent of patients met the MCID for improvement in activity NPRS, with night symptoms, workers' compensation status, and smoking predictive of treatment failure. CONCLUSION/CONCLUSIONS:We observed that a substantial percentage of the population did not meet MCID for pain and function following treatment of low back pain with physical therapy. Common risk factors for treatment failure included smoking and presence of night symptoms. LEVEL OF EVIDENCE/METHODS:4.
PMID: 26890953
ISSN: 1528-1159
CID: 4201252
