Implementation and Efficacy of Selective Sonographic Screening for Carotid Disease before Cardiac Surgery
| Autor: | Stefanie Schreiber, Julia Schoof, Michael Goertler, Hans-Jochen Heinze, Siegfried Kropf, Christof Huth, Alf Kozian |
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| Rok vydání: | 2010 |
| Předmět: |
Carotid Artery Diseases
Male medicine.medical_specialty Heart Diseases Disease Risk Assessment Severity of Illness Index Preoperative care Predictive Value of Tests Risk Factors Preoperative Care Severity of illness medicine Humans Mass Screening Cardiac Surgical Procedures Ultrasonography Doppler Color Aged Cardiopulmonary Bypass Chi-Square Distribution business.industry Patient Selection Cardiogenic shock Ultrasonography Doppler General Medicine Middle Aged medicine.disease Cardiac surgery Stroke Logistic Models Treatment Outcome ROC Curve Predictive value of tests Female Surgery Radiology Cardiology and Cardiovascular Medicine Risk assessment business Chi-squared distribution Program Evaluation |
| Zdroj: | Annals of Vascular Surgery. 24:382-387 |
| ISSN: | 0890-5096 |
| DOI: | 10.1016/j.avsg.2009.11.007 |
| Popis: | Background Preoperative carotid sonography with consecutive preventive strategies might reduce stroke risk during cardiac surgery. Since routine sonography in all patients may be unfeasible, an approach to examine preselected patients was investigated. Methods A prognostic model predicting carotid disease was developed using the clinical data of 1,768 routinely examined patients. It recommended 1,018 of 4,814 patients of a following collective for selective sonography. Patients recommended for preoperative sonography were compared to those selected in clinical practice. Results Besides the evaluated predictor variables, a history of syncope/cardiogenic shock and of pulmonary disease was associated with patient selection for sonography in clinical practice, even though both variables were not associated with severe carotid disease. In patients who underwent sonography, although this was not recommended by the prognostic model, severe carotid disease was estimated lower than what was actually detected, suggesting a change in relative relevance of predicting variables along with the change in frequencies of patients' cardiovascular characteristics. Conclusion Prognostic models for selective screening before cardiac surgery may require reevaluation over time, especially when baseline characteristics used for prediction have changed. Criteria used in clinical practice to select patients for screening may differ from those recommended by investigational studies. |
| Databáze: | OpenAIRE |
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