Role and Utility of Cranial and Abdominal Ultrasound Screening in Patients Undergoing Cardiac Surgery Open Access
Ciccotello, Carrie (Spring 2018)
Abstract
Background: Ultrasound is commonly used as a screening tool for extracardiac anomalies in
infants undergoing cardiac surgery. The goal of our study was to assess the utility of cranial
ultrasound (CUS) and abdominal ultrasound (AUS) as a screening tool by determining the
prevalence of intracranial anomalies in the Congenital Heart Disease (CHD) population and
evaluating the cost associated with screening.
Methods: Both cranial and abdominal ultrasounds were performed at our center using a
standardized protocol. We performed a retrospective study between 2006-2014 to obtain
demographic, diagnostic, procedural and outcomes data to assess for cranial and renal
pathologies.
Results: Of 1045 patients, 92 (8.3%) were found to have minor anomalies (no clinical
significance) on the CUS while only 11 (~1%) were found to have major abnormalities. Of those
with major pathologies, 5 had a follow-up CT and 8 had follow-up MRI. All advanced imaging
confirmed CUS findings and thus suggests CUS has 100% specificity for major anomalies.
Follow-up studies were performed as clinically indicated and resulted in slightly higher
detection of major abnormalities via CUS (6-7%).
881 screening AUS were performed resulting in diagnosis of 247 (28%) minor abnormalities (no
clinical significance) and 49 major (5.6%) renal morbidities.
Lastly, cost analysis using average hospital Medicaid fees showed that the cost of detecting one
major anomaly using screen CUS is $10,835.57 and using screening AUS is $2,464.29.
Conclusion: In a large study of infants receiving screening cranial and abdominal ultrasounds,
prevalence of extracardiac anomalies was very low. Of the ~1% with major cranial anomalies
detected by ultrasound, all diagnoses were confirmed by CT or MRI. Thus, the CUS specificity is
100% in our experience. We also determined prevalence of major renal abnormalities to be
5.6%. We concluded that there is a major cost associated with using ultrasound as a screening
test and the low yield may not justify its routine use. We suggest a strategy of directed
screening and comprehensive follow up program to ameliorate added morbidity and mortality
as caused by extra-cardiac abnormalities.
Table of Contents
Background……………………………………………………………………………………………………………………………1
Methods.……………………………….………………………………………………………………………………………………4
Results…………………………………………………………………………………………………………………………………..6
Demographics……………………..…………………………………………………………………………………………6
Ultrasound…………..…………………………………………………………………………………………………………6
Cranial Ultrasound Follow Up Studies……………….……………………………………………………………7
Advanced Neuroimaging………………………………..………………………………………………………………9
Cost Analysis…………………………………..…………………………………………………………..…………………9
Discussion………………….……………………..…………………………………………………………………………………10
Conclusion……………………………………………………………………………………………………………………………15
Tables and Figures……………………….………………………………………………………………………………………16
Table 1…………………………………….……………………………………………………………………………………16
Table 2………………………….………………………………………………………………………………………………17
Table 3……………………….…………………………………………………………………………………………………17
Table 4……………………….…………………………………………………………………………………………………18
Table 5………….……………………………………………………………………………………………………………..20
Table 6………….……………………………………………………………………………………………………………..20
Figure 1……………..…………………………………………………………………………………………………………21
Figure 2……..…………………………………………………………………………………………………………………21
References………………..…………………………………………………………………………………………………………22
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