Can Bedside Ultrasound Inferior Vena Cava Measurements Accurately Diagnose Congestive Heart Failure in the Emergency Department? A Clin-IQ

Congestive heart failure (CHF) is a major cause of morbidity and mortality. Early diagnosis of CHF in patients presenting to the emergency department with undifferentiated dyspnea would allow clinicians to begin appropriate treatment more promptly. Current guidelines recommend B-type natriuretic peptide (BNP) levels for more accurate diagnosis of CHF in dyspneic patients. Although BNP levels are relatively inexpensive, the test is not usually performed at bedside and results may take up to an hour or more. BNP also may have a “gray zone” in which the values can neither confirm nor rule out CHF. BNP has a reported sensitivity of 87% and specificity of 74% at a cutoff of 400 pg/ml. Studies investigating bedside ultrasound inferior vena cava (IVC) measurements for identifying CHF report a specificity of 84% to 96% and sensitivity values ranging from 37% to 93%, depending on the study. Given that ultrasound IVC measurements are performed at bedside and results are available rapidly, it is reasonable to evaluate whether ultrasound IVC measurements obtained by appropriately trained emergency department clinicians, alone or in combination with BNP, may increase diagnostic accuracy of CHF

Can Bedside Ultrasound Inferior Vena Cava Measurements Accurately Diagnose Congestive Heart Failure in the Emergency Department? A Clin-IQ

Congestive heart failure (CHF) is a major cause of morbidity and mortality. Early diagnosis of CHF in patients presenting to the emergency department with undifferentiated dyspnea would allow clinicians to begin appropriate treatment more promptly. Current guidelines recommend B-type natriuretic peptide (BNP) levels for more accurate diagnosis of CHF in dyspneic patients. Although BNP levels are relatively inexpensive, the test is not usually performed at bedside and results may take up to an hour or more. BNP also may have a “gray zone” in which the values can neither confirm nor rule out CHF. BNP has a reported sensitivity of 87% and specificity of 74% at a cutoff of 400 pg/ml. Studies investigating bedside ultrasound inferior vena cava (IVC) measurements for identifying CHF report a specificity of 84% to 96% and sensitivity values ranging from 37% to 93%, depending on the study. Given that ultrasound IVC measurements are performed at bedside and results are available rapidly, it is reasonable to evaluate whether ultrasound IVC measurements obtained by appropriately trained emergency department clinicians, alone or in combination with BNP, may increase diagnostic accuracy of CHF

Can Bedside Ultrasound Inferior Vena Cava Measurements Accurately Diagnose Congestive Heart Failure in the Emergency Department? A Clin-IQ

Congestive heart failure (CHF) is a major cause of morbidity and mortality. Early diagnosis of CHF in patients presenting to the emergency department with undifferentiated dyspnea would allow clinicians to begin appropriate treatment more promptly. Current guidelines recommend B-type natriuretic peptide (BNP) levels for more accurate diagnosis of CHF in dyspneic patients. Although BNP levels are relatively inexpensive, the test is not usually performed at bedside and results may take up to an hour or more. BNP also may have a “gray zone” in which the values can neither confirm nor rule out CHF. BNP has a reported sensitivity of 87% and specificity of 74% at a cutoff of 400 pg/ml. Studies investigating bedside ultrasound inferior vena cava (IVC) measurements for identifying CHF report a specificity of 84% to 96% and sensitivity values ranging from 37% to 93%, depending on the study. Given that ultrasound IVC measurements are performed at bedside and results are available rapidly, it is reasonable to evaluate whether ultrasound IVC measurements obtained by appropriately trained emergency department clinicians, alone or in combination with BNP, may increase diagnostic accuracy of CHF

Characteristics of randomized controlled trials published in the three highest-impact journals between January 1, 2010 and December 31, 2015.

<p>Characteristics of randomized controlled trials published in the three highest-impact journals between January 1, 2010 and December 31, 2015.</p

Year-by-year frequency of major discrepancies between published and registered outcomes in RCTs registered before or during patient enrollment (n = 181), and the effect of these discrepancies on the statistical significance of published outcomes, by year.

<p>Year-by-year frequency of major discrepancies between published and registered outcomes in RCTs registered before or during patient enrollment (n = 181), and the effect of these discrepancies on the statistical significance of published outcomes, by year.</p

Systematic review: Outcome reporting bias is a problem in high impact factor neurology journals

<div><p>Background</p><p>Selective outcome reporting is a significant methodological concern. Comparisons between the outcomes reported in clinical trial registrations and those later published allow investigators to understand the extent of selection bias among trialists. We examined the possibility of selective outcome reporting in randomized controlled trials (RCTs) published in neurology journals.</p><p>Methods</p><p>We searched PubMed for randomized controlled trials from Jan 1, 2010 –Dec 31, 2015 published in the top 3 impact factor neurology journals. These articles were screened according to specific inclusion criteria. Each author individually extracted data from trials following a standardized protocol. A second author verified each extracted element and discrepancies were resolved. Consistency between registered and published outcomes was evaluated and correlations between discrepancies and funding, journal, and temporal trends were examined.</p><p>Results</p><p>180 trials were included for analysis. 10 (6%) primary outcomes were demoted, 38 (21%) primary outcomes were omitted from the publication, and 61 (34%) unregistered primary outcomes were added to the published report. There were 18 (10%) cases of secondary outcomes being upgraded to primary outcomes in the publication, and there were 53 (29%) changes in timing of assessment. Of 82 (46%) major discrepancies with reported p-values, 54 (66.0%) favored publication of statistically significant results.</p><p>Conclusion</p><p>Across trials, we found 180 major discrepancies. 66% of major discrepancies with a reported p-value (n = 82) favored statistically significant results. These results suggest a need within neurology to provide more consistent and timely registration of outcomes.</p></div

Published RCTs that were registered before or during trial completion and have major discrepancies with their trial registries, and the effect of these discrepancies on the statistical significance of published outcomes, by funding source.

<p>Published RCTs that were registered before or during trial completion and have major discrepancies with their trial registries, and the effect of these discrepancies on the statistical significance of published outcomes, by funding source.</p