Electronic Medical Record Review as a Surrogate to Telephone Follow-up to Establish Outcome for Diagnostic Research Studies in the Emergency Department

Kline, Jeffrey A.; Mitchell, Alice M.; Runyon, Michael S.; Jones, Alan E.; Webb, William B.

doi:10.1111/j.1553-2712.2005.tb00840.x

Cited by 56 publications

(47 citation statements)

References 23 publications

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“…6 Adjudicators agreed on the outcome of 298 ⁄ 304 patients, with a third person required to determine the final outcome for 6 patients (Cohen's Kappa 0.87, 95% CI = 0.80 to 0.94). A VTE was identified in 22 ⁄ 304 patients (7%; 95% CI = 5% to 11%) within the 90-day follow-up period: 5 patients had both PE and DVT, 5 patients had PE but no DVT, 6 patients had isolated DVT, and 6 were diagnosed with PE, but were not evaluated for DVT.…”

Section: Resultsmentioning

confidence: 99%

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Direct Comparison of the Diagnostic Accuracy of Fifty Protein Biological Markers of Pulmonary Embolism for Use in the Emergency Department

Nordenholz

Mitchell

Kline

2008

Academic Emergency Medicine

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Objectives: Pulmonary embolism (PE) is associated with abnormal concentrations of many proteins involved in inflammation, hemostasis, and vascular injury. The authors quantified the diagnostic accuracy of a battery of protein biological markers for the detection of PE in emergency department (ED) patients.Methods: A random and a consecutive sample of ED patients evaluated for PE were prospectively enrolled at two academic EDs between August 2005 and April 2006. A plasma sample was obtained at enrollment, and all patients were followed by telephone and medical record review at 90 days for the development of venous thromboembolism (VTE) defined as PE or deep venous thrombosis (DVT), requiring the consensus of two of three blinded physician reviewers. Measurements of potential biological markers were performed by technicians blinded to the study objectives. The diagnostic accuracy of each biological marker was determined by the area under the receiver operating characteristic (ROC) curve.

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Section: Resultsmentioning

confidence: 99%

“…We performed the literature-supported 90-day follow-up as the criterion standard for VTE diagnosis. 6 Two patients of 22 with VTE were diagnosed after the time of enrollment. One had a negative initial evaluation for PE and returned (within the week) in disseminated intravascular coagulation from acute leukemia and died.…”

Section: Limitationsmentioning

confidence: 99%

Direct Comparison of the Diagnostic Accuracy of Fifty Protein Biological Markers of Pulmonary Embolism for Use in the Emergency Department

Nordenholz

Mitchell

Kline

2008

Academic Emergency Medicine

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“…The secondary end point was the composite of either severe renal failure or death with renal failure as a contributing cause within 45 d. We followed patients for 45 d, using a combination of telephone and medical record review. The methods of follow-up have been previously published (19). Severe renal failure was defined as a rise in sCr to Ն3.0 mg/dl (3) or the need for dialysis.…”

Section: Outcome Measuresmentioning

confidence: 99%

Incidence of Contrast-Induced Nephropathy after Contrast-Enhanced Computed Tomography in the Outpatient Setting

Mitchell¹,

Jones²,

Tumlin³

et al. 2010

Clinical Journal of the American Society of Nephrology

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246

192

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Background and objectives: No prospective study has reported the incidence of contrast-induced nephropathy (CIN) or the associated morbidity and mortality after contrast-enhanced computed tomography (CECT) in the outpatient setting.Design, setting, participants, & measurements: We enrolled and followed a prospective, consecutive cohort (June 2007 through January 2009) of patients who received intravenous contrast for CECT in the emergency department of a large, academic, tertiary care center. Outcomes measured were as follows (1) CIN: An increase in serum creatinine >0.5 mg/dl or >25% 2 to 7 d after contrast administration; (2) severe renal failure: An increase in serum creatinine to >3.0 mg/dl or the need for dialysis at 45 d; and (3) renal failure as a contributing cause of death (consensus of three independent physicians) at 45 d.Results: The incidence of CIN was 11% (70 of 633) among the 633 patients enrolled. Fifteen (2%) patients died within 45 d, including six deaths after study-defined CIN. Seven (1%) patients developed severe renal failure, six of whom had studydefined CIN. Of the six patients with CIN and severe renal failure, four died, and adjudicators determined that renal failure significantly contributed to all four deaths. Thus, CIN was associated with an increased risk for severe renal failure and death from renal failure.Conclusions: CIN occurs in >10% of patients who undergo CECT in the outpatient setting and is associated with a significant risk for severe renal failure and death.

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“…The details of the method of follow-up have been previously described and included a combination of telephone contact and medical record review. 12 The primary outcome of VTE positive (VTE+)or VTE negative (VTE)) was based on adjudication requiring the consensus of two of three reviewers who had access to a structured set of data including clinical laboratory tests, imaging results, and source documentation. Reviewers were blinded to the results of study markers and the outcome determinations of the other reviewers.…”

Section: Outcome Measuresmentioning

confidence: 99%

Tandem Measurement of D‐dimer and Myeloperoxidase or C‐reactive Protein to Effectively Screen for Pulmonary Embolism in the Emergency Department

Mitchell

Nordenholz

Kline

2008

Academic Emergency Medicine

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Objectives: The hypothesis was that the tandem measurement of D-dimer and myeloperoxidase (MPO) or C-reactive protein (CRP) could significantly decrease unnecessary pulmonary vascular imaging in emergency department (ED) patients evaluated for pulmonary embolism (PE) compared to D-dimer alone.Methods: The authors measured the sequential combinations of D-dimer and MPO and D-dimer and CRP in a prospective sample of ED patients evaluated for PE at two centers. Patients were followed for 90 days for venous thromboembolism (VTE, either PE or deep venous thrombosis [DVT]), which required the consensus of two of three blinded physician reviewers. Results:The authors enrolled 304 patients, 22 with VTE (7%; 95% confidence interval [CI] = 5% to 10%). The sensitivity and specificity of a D-dimer alone (cutoff ‡ 500 ng ⁄ mL) were 100% (95% CI = 85% to 100%) and 59% (95% CI = 53% to 65%), respectively, and was followed by pulmonary vascular imaging negative for PE in 38% (115 ⁄ 304; 95% CI = 32% to 44%). The combination of either a negative D-dimer, or MPO < 22 mg ⁄ dL, had a sensitivity of 100% and specificity of 73% (95% CI = 67% to 78%). Thus, tandem measurement of D-dimer and MPO would have decreased the frequency of subsequent negative pulmonary vascular imaging from 38% to 25% (95% CI of the difference of )13% = )5% to )20%). The combination of CRP and D-dimer would not have significantly improved the rate of negative imaging. Conclusions:The tandem measurement of D-dimer and MPO would have significantly decreased negative pulmonary vascular imaging compared with D-dimer alone and should be validated prospectively. ACADEMIC EMERGENCY MEDICINE 2008; 15:800-805 ª 2008 by the Society for Academic Emergency MedicineKeywords: biological markers, pulmonary embolism E mergency physicians' awareness of pulmonary embolism (PE) as an important and potentially life-threatening illness is increasing. Currently, emergency physicians employ a diagnostic strategy that involves an assessment of pretest probability based on clinical evaluation followed by D-dimer testing in low-and moderate-risk patients. Patients with a positive D-dimer, or those at high risk, generally defined as a pretest probability for venous thromboembolism (VTE) of about 40% or greater, go on to pulmonary vascular imaging.1 While the D-dimer has proven to be a sensitive marker for PE, a low specificity leads to frequent negative pulmonary vascular imaging.Pulmonary vascular imaging is a significant source of the overall increase in imaging studies performed in emergency departments (EDs). Currently, approximately 10% of ED patients receive either a computed tomography (CT) scan or magnetic resonance imaging as a part of their ED care, and more than 1% receive

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Electronic Medical Record Review as a Surrogate to Telephone Follow-up to Establish Outcome for Diagnostic Research Studies in the Emergency Department

Abstract: Under limited circumstances, accurate clinical follow-up for diagnostic studies conducted in the ED can be obtained by medical record review.

Cited by 56 publications

References 23 publications

Direct Comparison of the Diagnostic Accuracy of Fifty Protein Biological Markers of Pulmonary Embolism for Use in the Emergency Department

Direct Comparison of the Diagnostic Accuracy of Fifty Protein Biological Markers of Pulmonary Embolism for Use in the Emergency Department

Incidence of Contrast-Induced Nephropathy after Contrast-Enhanced Computed Tomography in the Outpatient Setting

Tandem Measurement of D‐dimer and Myeloperoxidase or C‐reactive Protein to Effectively Screen for Pulmonary Embolism in the Emergency Department

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