Author(s): Staal J.; Kariki E.; Hyatt R.; Javaid M.K.; Russell E.; aO'Neill T.; Poole K.; Chappell D.; Rajak R.
Source: Osteoporosis International; 2018; vol. 29 (no. 1)
Publication Date: 2018
Publication Type(s): Conference Abstract
Abstract:Objective: Vertebral fragility fractures (VFFs) are an early manifestation of osteoporosis. VFFs may triple the risk of future hip fracture1 yet VFF patients are often underrepresented in Fracture Liaison Services (FLSs). We assessed the rate of VFFs in computed tomography (CT) scans of the thorax, abdomen and pelvis and reviewed whether they had been previously reported. We also investigated whether the identified VFF patients had been referred to an FLS. Methods: We retrospectively audited pseudonymised CT scans of patients 50 years and older, containing the spine, and performed over a 12-month period at 5 NHS hospitals in the UK (Cambridge, Croydon, East Lancashire, Oxford and Salford). We used the Optasia Medical ASPIRETM service, a commercial casefinding service combining machine learning with radiologist overread (EK). VFFs were classified using the Genant-SQ method and only moderate and severe VFFs were included. We compared our findings with the original radiology reports. Results:We collected 47,889 scans (50.1%) and used a sample of 1638 scans for analysis. Of these, 237 patients (53.4% ) had VFFs (14.5%+/-1.7%, 95%CI). VFF prevalence between sites was not significantly different. Four sites (Ca., Cr., E.L., Ox.) checked the original radiology reports and FLS referral. The median reporting rate was 67.7% (IQR 55.7%, 74.5%) and the median FLS referral was 13.3% (IQR 10.8%, 22.0%). Conclusions: On average, 1 in 7 patients had at least one moderate VFF with a median of 13.3% being seen by the FLS. Whilst men are underrepresented in FLSs2, nearly as many men as women were found to have VFFs. Opportunistic diagnosis of VFF can greatly increase the number of patients referred to FLSs, potentially protecting the patients' quality of life and decreasing the economic burden of osteoporosis.
Upper Tract Imaging in Patients with Initial or Terminal Hematuria Suggestive of Bleeding from the Lower Urinary Tract: How Often is the Upper Urinary Tract Responsible for the Hematuria?
Author(s): Al-Mula Abed, Omar W. S.; Srirangam, Shalom J.; Wemyss-Holden, Guy D.
Source: Oman Medical Journal; Sep 2018; vol. 33 (no. 5); p. 374-379
Publication Date: Sep 2018
Publication Type(s): Academic Journal
Available at Oman Medical Journal - from Europe PubMed Central - Open Access
Abstract:Objectives: Visible hematuria (VH) is a common urological complaint. A history of initial or terminal VH in men is indicative of a lower urinary tract (LUT) source. A careful clinical history could limit unnecessary extensive upper tract imaging in this group of patients with VH. We conducted a single-center prospective study to examine the usefulness of investigating the upper tract in patients with a history of VH likely from a LUT source (initial and/or terminal VH) with specific reference to the incidence of demonstrable significant upper tract abnormalities. Methods: We conducted a single-center prospective study of consecutive male patients presenting with VH over eight months. All patients underwent standard investigations including physical examination, flexible cystoscopy (FC), and radiological imaging (ultrasound scan (USS) and/or computed tomography urogram (CTU)). Those with a clear history of initial or terminal VH were identified for further scrutiny with regards to detectable upper tracts abnormalities. Results: In total, 57 patients (aged 23--95 years) with initial or terminal VH were identified. Of these, 56 had FC and nine patients were subsequently diagnosed with a LUT malignancy. With regards to upper urinary tract (UUT), 35 patients (61.4%) had an USS, 46 (80.7%) underwent a CTU, and 25 (43.9%) patients had both. In this group, no UUT malignancy was identified on upper tract imaging. Conclusions: Initial or terminal VH patients may not need extensive upper tract imaging. FC is recommended, but a non-invasive USS can be a safe initial investigation for the UUT, with a CTU subsequently considered in those with abnormalities on USS and those with ongoing bleeding. Further combined multicenter analysis will help corroborate these findings and could have several beneficial outcomes including a reduction in investigations cost, patient inconvenience, and ionizing radiation.
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