The first link in the 'chain of survival' is the activation of Emergency Medical Services (EMS). In the major part of Denmark, police officers operate the alarm 1-1-2 centre, including calls for EMS. Our aim was to study the police 1-1-2 operators' accuracy in identifying calls concerning patients with loss of consciousness as a key symptom of life-threatening conditions. 'Unconsciousness' was defined as patients with a Glasgow Coma Scale (GCS) score of or = 9, 972 of whom were reported 'awake', giving a specificity of 72%. The positive predictive value (percentage of patients found with a GCS score of
During a 1-year period 4785 intraoperative consultations were performed. The pathology reports were retrospectively reviewed to determine the accuracy of frozen section diagnosis in various tissue types. Skin for evaluation of section margins and axillary sentinel lymph nodes for evaluation of metastatic disease were most frequently sent for frozen section diagnosis. The number of discordant cases were 182, 178 were false negative and four were false positive. When frozen section diagnoses were compared with permanent section diagnoses, the overall diagnostic concordance was 95.1%. The number of deferred specimens was 57. The accuracy of frozen section diagnosis varied between tissue types, and axillary sentinel lymph nodes accounted for the greatest number of discordances. In conclusion, the frozen section diagnosis is a reliable method with varying concordance and deferral rates between tissue types. We suggest regular monitoring of the performance in frozen section diagnosis.
To evaluate the possibility of applying the Third Molar Eruption Predictor to all panoramic radiographs.
Panoramic radiographs were retrospectively analyzed from a 4-year follow-up study of third molars carried out at the University of Copenhagen, Denmark. The radiographs, taken at a mean age of 20.6 years, included 45 unerupted or partially erupted mandibular third molars in 28 subjects. Because the device was calibrated both with simple proportions and by use of the methods of Bayes' Decision Theory, the separation point of the device was therefore adjusted at 12 mm from the distal surface of the second molar.
The predictions of future eruption or impaction made with the calibrated device and the actual clinical outcome 4 years later were in conformity for 80% of the mandibular third molars.
The Third Molar Eruption Predictor may be applied to all panoramic radiographs, but it seems to require calibration before use.
Psychological resistance may be of considerable importance in the posttraumatic stress disorder (PTSD) population, considering that researchers in the field of traumatic stress are frequently unsuccessful in achieving high response rates, that many subjects suffering from PTSD never seek help, and that dropouts from therapy are frequent. This article presents data on the main complaints reported in the acute aftermath of an industrial disaster by 246 employees who had been exposed to the disaster. The dominant concerns were symptomatic complaints related to posttraumatic stress reactions rather than external problems. Sleep disturbance, anxiety/fear responses, and physical symptoms were reported by individuals with complaints in the acute phase as most problematic, while irritability and depressive symptoms appeared very infrequently among the reported main complaints. A high specificity and sensitivity were achieved in predicting later PTSD (as defined by DSM-III criteria) by applying early response variables: thus, there were few false-positives and false-negatives. There was a considerable overlap between the PTSD predictors and the main symptom complaints. From a prevention point of view, this should be advantageous, since it would bring the right people to seek help. However, in a significant proportion of the acutely distressed, the reluctance to seek help was motivated by the very symptoms that predicted PTSD. Even a relatively high rate of subjects agreeing to be screened (82.8%) would have lost 42% of those who qualified for a diagnosis of PTSD, and more than half of the subjects with severe outcomes would not have been included. For primary and secondary prevention, the findings suggest that early screening and outreach should be very active.
This study was conducted to gain insight into the diagnosis, treatment, and outcome measures in adult patients presenting with acute epiglottitis.
A retrospective clinical study was conducted on fifty-seven consecutive adult patients presenting with acute epiglottitis over a 13-year period to The Toronto Hospital, University of Toronto. Demographic description of patient population, presenting symptoms and signs, investigations performed, treatment provided, and incidence of complications were described.
Soft-tissue lateral neck x-rays were abnormal in 88.1% of patients tested but had a 12% false-negative rate. Indirect, direct, or flexible laryngoscopy were the most accurate investigations to establish diagnosis and were not associated with any complications. Four of 45 patients (8.9%) had positive blood cultures for Haemophilus influenzae, with the remainder demonstrating no growth, while 22% of patients (8/36) grew possible pathogenic organisms on throat culture. A rapid clinical course (
The accuracy (sensitivity and positive predictive value) of the clinical diagnosis given by the general practitioner before admission to hospital was evaluated retrospectively in a population with epidemic meningococcal disease. The study population consisted of approximately 32,000 subjects. In a 12-year period, 344 patients were discharged from hospital with CNS infections, 274 of whom were admitted with a diagnosis suspecting a CNS infection. A further 401 patients were admitted with suspicion for, but discharged without a CNS infection. Overall, the sensitivity was 79.7% and the positive predictive value was 40.6%. There were no significant changes in the accuracy during the study. The sensitivity differed significantly between the age groups (P less than 0.001) and was lowest among the adults (15+ years, 67.9%) and the 0-2-year-old children (72.7%). Also among the 0-2 year-olds, the positive predictive value was low (34.1%) and not significant, indicating that it was more difficult to obtain the correct clinical diagnosis in this group.
Experience with the diagnosis of neural tube defects from alpha1-fetoprotein (AFP) concentrations in amniotic fluid is reported from a prospective study of five laboratories testing for 13 Canadian genetic centres. The results of the study indicate that antenatal diagnosis of open neural tube defects is being carried out effectively in Canada (in 99.2% of cases the AFP measurements were interpreted correctly). Amniocentesis should be recommended to women at high risk for having a child with a neural tube defect (i.e., those who have a child, a parent or a sibling with a neural tube defect). The rate of neural tube defects in 182 high-risk pregnancies was 2.2% for an open defect and 1.1% for a closed defect, whereas the rate in 673 pregnancies in which amniocentesis was being performed for other reasons was 0.3%. This suggests that the AFP concentration should be measured in any sample of amniotic fluid collected for other reasons (usually fetal karyotyping). There were three instances of false-negative results, for a rate of 0.4%. Two closed neural tube defects were not detected; this limitation of the test has also been found by others. One of the six fetuses with an open neural tube defect, who died in utero, had a large myelocele in the neck that was not recognized. There were also four instances of false-positive results, for a rate of 0.5%. The findings suggest that AFP values that are more than 2 but less than 7 standard deviations (SDs) above the mean may indicate a neural tube defect, and that values 7 or more SDs above the mean very likely indicate such a defect, although other reasons for such high values (e.g., fetal erythrocytes in the amniotic fluid, intrauterine death and mistaken gestational age) must be ruled out by other methods.
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Cites: Can Med Assoc J. 1976 Oct 23;115(8):739-4861796
The purpose of this study was to explore the accuracy of elevated liver function values, age, gender, pancreatitis and cholecystitis as predictors of common bile duct stones (CBDS).
All patients operated on for gallstone disease over a period of 3 years in a Swedish county of 302,564 citizens were registered prospectively. Intraoperative cholangiography (IOC) was used to detect CBDS.
A total of 1171 patients were registered; 95% of these patients underwent IOC. Common bile duct stones were found in 42% of patients with elevated liver function values, 20% of patients with a history of pancreatitis and 9% of patients with cholecystitis. The presence of CBDS was significantly predicted by elevated liver function values, but not by age, gender, history of acute pancreatitis or cholecystitis. A total of 93% of patients with normal liver function tests had a normal IOC. The best agreement between elevated liver function values and CBDS was seen in patients undergoing elective surgery without a history of acute pancreatitis or cholecystitis.
Although alkaline phosphatase (ALP) and bilirubin levels represented the most reliable predictors of CBDS, false positive and false negative values were common, especially in patients with a history of cholecystitis or pancreatitis, which indicates that other mechanisms were responsible for elevated liver function values in these patients.