Role and Utility of Cranial and Abdominal Ultrasound Screening in Patients Undergoing Cardiac Surgery Público

Ciccotello, Carrie (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/9k41zd51t?locale=es
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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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