Effectiveness of Outpatient Versus Operating Room Hysteroscopy for the Diagnosis and Treatment of Uterine Conditions: A Systematic Review and Meta-Analysis.

Traditionally, hysteroscopy has been performed in the main operating room with the patient under general anaesthesia. Hysteroscopy performed in an office setting avoids the risks of general anaesthesia. The aim of this review was to evaluate the effectiveness of outpatient hysteroscopy compared with hysteroscopy performed in the operating room to diagnose and/or treat intrauterine pathology. Relevant electronic databases were searched, including Medline, EMBASE, and the Cochrane Library. RCTs and nonrandomized studies that compared the efficacy of outpatient hysteroscopy and traditional hysteroscopy performed in the operating room were included. The primary outcome of interest was diagnostic accuracy, and secondary outcomes included treatment success, adverse events, pain, patient satisfaction, and cost. The Cochrane risk of bias tool was used to assess RCTs, and the Downs and Black tool was used for nonrandomized studies. A total of 12 658 abstracts and 347 full-text articles were assessed, from which a total of 20 full-text studies met our eligibility criteria. No study compared the diagnostic accuracy of outpatient hysteroscopy with hysteroscopy performed in the operating room. There was no significant difference between hysteroscopy performed in the outpatient and operating room setting for treatment success, adverse events, and patient satisfaction. In the included RCTs, there was greater reported postoperative pain in the outpatient setting (standard mean difference 0.19, 95% CI 0.01-0.37). All seven economic studies concluded that outpatient hysteroscopy (range US$97-1258) is substantially less expensive than hysteroscopy performed in the operating room (range US$258-3144). Included RCTs had serious risks of selection, performance, and detection bias. The results of this review demonstrate that implementing hysteroscopy in an outpatient setting without general anaesthesia should be thoughtfully considered. The current available evidence demonstrates greater reported postoperative pain in the outpatient setting and no statistically significant differences in all other studied outcome measures between outpatient and intraoperative hysteroscopy procedures.

Detection of hypertension and prehypertension in paediatric patients with type 1 diabetes using a simple blood pressure table.

BACKGROUND: The diagnosis of hypertension is often unrecognized in the general paediatric and type 1 diabetes populations. Reference to a simple blood pressure table has been proposed as a screening tool for the identification of abnormal paediatric blood pressure. This simple table lists one cut-off blood pressure value for each sex and year of age, compared with the standard blood pressure tables, which list 476 abnormal and normal blood pressure values. OBJECTIVE: To determine the sensitivity and specificity of the simple blood pressure table in identifying hypertensive and abnormal (hypertensive or prehypertensive) blood pressure values in children with type 1 diabetes. METHODS: A retrospective cohort study was conducted. Data regarding baseline characteristics and blood pressure measurements were collected. Blood pressure values were categorized as nonhypertensive, prehypertensive or hypertensive using the standard and simple blood pressure tables. Sensitivity and specificity of the simple blood pressure table was determined for the identification of hypertensive and abnormal (hypertensive or prehypertensive) blood pressure values using a generalized estimating equation approach. RESULTS: The simple blood pressure table had sensitivities of 100% (95% CI 95.7% to 100%) and 100% (95% CI 97.6% to 100%), and specificities of 61.1% (95% CI 54.0% to 67.8%) and 81.3% (95% CI 74.4% to 86.6%), for the identification of hypertensive and abnormal blood pressure values, respectively. CONCLUSION: The simple blood pressure table is an effective screening tool that may enable earlier detection and timely treatment of abnormal blood pressure.

HISTORIQUE: Le diagnostic d'hypertension demeure souvent non diagnostiqué dans les populations générale et atteinte du diabète de type 1 d'âge pédiatrique. On a proposé d'utiliser un tableau simplifié de la tension artérielle comme outil de dépistage d'une tension artérielle anormale en pédiatrie. Ce tableau simplifié indique une valeur seuil de tension artérielle selon le sexe et l'âge, par rapport aux tableaux de tension artérielle standards, qui contiennent 476 valeurs de tension artérielle anormales et normales. OBJECTIF: Déterminer la sensibilité et la spécificité du tableau simplifié de la tension artérielle pour déterminer les valeurs hypertensives et anormales (hypertension et préhypertension) de la tension artérielle chez des enfants atteints du diabète de type 1. MÉTHODOLOGIE: Les chercheurs ont mené une étude rétrospective de cohorte. Ils ont amassé des données relatives aux caractéristiques et aux mesures de tension artérielle de base. Ils ont classé les valeurs de tension artérielle entre non hypertensives, préhypertensives ou hypertensives au moyen des tableaux de la tension artérielle standard et simplifié. Ils ont déterminé la sensibilité et la spécificité du tableau simplifié de la tension artérielle pour déterminer les valeurs hypertensives et anormales (hypertension ou préhypertension) de la tension artérielle au moyen d'une approche d'équations d'estimation généralisées. RÉSULTATS: Le tableau simplifié de la tension artérielle présente une sensibilité de 100 % (95 % IC 95,7 % à 100 %) et de 100 % (95 % IC 97,6 % à 100 %), et une spécificité de 61,1 % (95 % IC 54,0 % à 67,8 %) et de 81,3 % (95 % IC 74,4 % à 86,6 %) pour déterminer des valeurs de tension artérielle hypertensives et anormales, respectivement. CONCLUSION: Le tableau simplifié de la tension artérielle est un outil de dépistage efficace qui peut favoriser un dépistage plus rapide et un traitement opportun de la tension artérielle anormale.

In-hospital mortality and surgical utilization in severely polytraumatized patients with and without spinal injury.

BACKGROUND: Patients who sustain major trauma experience multisystem injuries including those affecting the spine. We hypothesize that recovery after spinal injuries differs from those affecting other systems. The purpose of our study was to compare in-hospital mortality and surgical resource utilization in severely polytraumatized patient with and without spinal injury. METHODS: We assembled a cohort of patients with severe polytrauma (Injury Severity Score [ISS]>15) and spinal injury and matched them to a cohort without spinal injury for age, gender, ISS, and mechanism of injury. In patients presenting to a Level I trauma center, we compared in-hospital patient mortality, the number of surgical procedures, and duration required for ventilatory support, intensive care unit (ICU) length of stay (LOS), and in-hospital LOS comparing matched groups. We performed a subanalysis of those who sustained severe fracture types and those with neurologic impairment. RESULTS: From 114 matched pairs, we found no significant differences in mortality rates or numbers of surgical procedures performed between the groups. Patients with spine injury, however, were observed to experience a prolonged duration of ventilation, ICU and in-hospital LOS compared with their matched cohort. Severe fracture patterns and the presence of neurologic involvement amplified the effect on these outcomes. CONCLUSIONS: In this study, we conclude that the presence of a spinal injury in the setting of severe polytrauma (ISS>15) is associated with a prolonged course of ventilatory support, ICU, and in-hospital LOS. Trauma hospitals treating patients with spinal fracture should be aware of differences in the use of health services for this patient population.