3 research outputs found
Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT
(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases
High Specificity Wearable Device With Photoplethysmography and Six-Lead Electrocardiography for Atrial Fibrillation Detection Challenged by Frequent Premature Contractions: DoubleCheck-AF
Background: Consumer smartwatches have gained attention as mobile health
(mHealth) tools able to detect atrial fibrillation (AF) using photoplethysmography (PPG) or
a short strip of electrocardiogram (ECG). PPG has limited accuracy due to the movement
artifacts, whereas ECG cannot be used continuously, is usually displayed as a single-lead
signal and is limited in asymptomatic cases.
Objective: DoubleCheck-AF is a validation study of a wrist-worn device dedicated to
providing both continuous PPG-based rhythm monitoring and instant 6-lead ECG with
no wires. We evaluated its ability to differentiate between AF and sinus rhythm (SR) with
particular emphasis on the challenge of frequent premature beats.
Methods and Results: We performed a prospective, non-randomized study of 344
participants including 121 patients in AF. To challenge the specificity of the device
two control groups were selected: 95 patients in stable SR and 128 patients in
SR with frequent premature ventricular or atrial contractions (PVCs/PACs). All ECG
tracings were labeled by two independent diagnosis-blinded cardiologists as “AF,”
“SR” or “Cannot be concluded.” In case of disagreement, a third cardiologist was
consulted. A simultaneously recorded ECG of Holter monitor served as a reference. It
revealed a high burden of ectopy in the corresponding control group: 6.2 PVCs/PACs
per minute, bigeminy/trigeminy episodes in 24.2% (31/128) and runs of ≥3 beats
in 9.4% (12/128) of patients. AF detection with PPG-based algorithm, ECG of the
wearable and combination of both yielded sensitivity and specificity of 94.2 and
96.9%; 99.2 and 99.1%; 94.2 and 99.6%, respectively. All seven false-positive PPGbased cases were from the frequent PVCs/PACs group compared to none from the
stable SR group (P < 0.001). In the majority of these cases (6/7) cardiologists were able
to correct the diagnosis to SR with the help of the ECG of the device (P = 0.012).
Conclusions: This is the first wearable combining PPG-based AF detection algorithm
for screening of AF together with an instant 6-lead ECG with no wires for manual rhythm
confirmation. The system maintained high specificity despite a remarkable amount of
frequent single or multiple premature contraction
Six-lead electrocardiography compared to single-lead electrocardiography and photoplethysmography of a wrist-worn device for atrial fibrillation detection controlled by premature atrial or ventricular contractions: six is smarter than one
Smartwatches are commonly capable to record a lead-I-like electrocardiogram (ECG) and perform a photoplethysmography (PPG)-based atrial fibrillation (AF) detection. Wearable technologies repeatedly face the challenge of frequent premature beats, particularly in target populations for screening of AF