In the News

Radiation safety, VTE hospitalization risk, and more.

Cardiovascular imaging societies develop plan for radiation safety

A think tank of cardiovascular imaging stakeholders developed a consensus plan on several broad directions for ensuring patient safety in an era of increased medical radiation.

Physicians need to perform only appropriate and necessary diagnostic exams and procedures, consider exams or procedures without radiation, and use the best possible combination of equipment, doses and protocols, according to a report written by a collaboration of eight medical societies and Duke University Clinical Research Institute.

The four critical areas covered by the plan are:

  1. 1. Quantifying the estimated risks of malignancies that may occur much later from low-dose radiation of cardiovascular imaging and therapies;
  2. 2. Measuring and reporting radiation dose in cardiovascular imaging and procedures;
  3. 3. Minimizing radiation dose for single episodes of care and across entire systems of care; and
  4. 4. Educating and communicating with multiple groups to increase awareness and achieve goals in minimizing exposure.

The full text of the report was published in the May 15 Journal of the American College of Cardiology, as well as in Circulation: Journal of the American Heart Association.

Infection, other factors may increase VTE hospitalization risk

Infection, treatment with erythropoiesis-stimulating agents, and blood transfusion may increase risk for hospitalization due to venous thromboembolism (VTE), according to a recent study.

Researchers used data from the Health and Retirement Study, a nationally representative, ongoing, longitudinal study of Americans at least 51 years of age, to perform a case-crossover study examining risk factors for VTE hospitalization. Data from the study were linked with Medicare files for hospital and nursing home stays and emergency department, outpatient and home health visits from 1991 to 2007. The authors compared exposures to potential risk factors in the 90 days before hospital admission in patients admitted with a principal diagnosis of deep venous thrombosis or pulmonary embolism to the same patients' exposures during the four previous 90-day periods. A 90-day washout period was observed between the risk and comparison periods. The main outcome was hospitalization for VTE. The study results were published in the May 1 Circulation.

A total of 16,781 patients with 399 index VTE hospitalizations were included. The most common predictor of hospitalization for VTE was infection (52.4% of risk periods), with adjusted incidence rate ratios (IRRs) of 2.90 (95% CI, 2.13 to 3.94) for all infection, 2.63 (95% CI, 1.90 to 3.63) for infection without a previous stay in a hospital or skilled nursing facility and 6.92 (95% CI, 4.46 to 10.72) for infection with a previous stay in a hospital or skilled nursing facility. An association was also seen between VTE hospitalization and treatment with erythropoiesis-stimulating agents (IRR, 9.33; 95% CI, 1.19 to 73.42) and blood transfusion (IRR, 2.57; 95% CI, 1.17 to 5.64). Major surgeries, fractures, immobility and chemotherapy also appeared to contribute to VTE hospitalization risk.

The authors concluded that infection, erythropoiesis-stimulating agents and blood transfusion are associated with increased risk for VTE hospitalization and that risk prediction algorithms should be updated to include these factors.

An accompanying editorial called for additional studies using “more robust” data sets to confirm and expand on these findings, especially in younger patients, but agreed that “acute infection, particularly a more severe infection that requires hospitalization, should be considered a trigger for acute VTE.” The study's findings “provide evidence suggesting that blood transfusion and treatment with erythropoiesis-stimulating agents should now be considered as possible triggers for acute VTE in non-cancer patients,” the editorialist added.

Guideline issued on acute bacterial rhinosinusitis

The Infectious Diseases Society of America (IDSA) issued a guideline on the diagnosis and management of acute bacterial rhinosinusitis, offering ways to distinguish bacterial from viral infection and stressing appropriate use of antibiotics.

The guideline was developed by an 11-member multidisciplinary expert panel that included representatives from several organizations. It is the IDSA's first guideline on this topic, and describes the characteristics of bacterial versus viral sinus infections to help clinicians better differentiate between the two. Antibiotics are not recommended for most sinus infections because 90% to 98% are caused by viruses, the guideline said.

An infection probably has a bacterial cause and warrants antibiotics if symptoms last for at least 10 days and are not improving; if symptoms are severe, such as a temperature of at least 102° and facial pain for three to four successive days; and if symptoms worsen, usually after a viral upper respiratory infection of five or six days' duration that seemed to be improving. In patients who do have a bacterial sinus infection, the guideline recommends amoxicillin-clavulanate rather than amoxicillin alone, because clavulanate protects against antibiotic resistance. Common antibiotics such as azithromycin, clarithromycin and trimethoprim-sulfamethoxazole are not recommended because of resistance issues. The guideline, which appeared in the April 15 Clinical Infectious Diseases, also recommends adult antibiotic treatment last five to seven days, not 10-14 days.