The effect of circle of willis anatomy and scanning practices on outcomes for blunt cerebrovascular injuries.

BACKGROUND: Limited research has explored the effect of Circle of Willis (CoW) anatomy among blunt cerebrovascular injuries (BCVI) on outcomes. It remains unclear if current BCVI screening and scanning practices are sufficient in identification of concomitant COW anomalies and how they affect outcomes. METHODS: This retrospective cohort study included adult traumatic BCVIs at 17 level I-IV trauma centers (08/01/2017-07/31/2021). The objectives were to compare screening criteria, scanning practices, and outcomes among those with and without COW anomalies. RESULTS: Of 561 BCVIs, 65% were male and the median age was 48 y/o. 17% (n = 93) had a CoW anomaly. Compared to those with normal CoW anatomy, those with CoW anomalies had significantly higher rates of any strokes (10% vs. 4%, p = 0.04), ICHs (38% vs. 21%, p = 0.001), and clinically significant bleed (CSB) before antithrombotic initiation (14% vs. 3%, p < 0.0001), respectively. Compared to patients with a normal CoW, those with a CoW anomaly also had ischemic strokes more often after antithrombotic interruption (13% vs. 2%, p = 0.02).Patients with CoW anomalies were screened significantly more often because of some other head/neck indication not outlined in BCVI screening criteria than patients with normal CoW anatomy (27% vs. 18%, p = 0.04), respectively. Scans identifying CoW anomalies included both the head and neck significantly more often (53% vs. 29%, p = 0.0001) than scans identifying normal CoW anatomy, respectively. CONCLUSIONS: While previous studies suggested universal scanning for BCVI detection, this study found patients with BCVI and CoW anomalies had some other head/neck injury not identified as BCVI scanning criteria significantly more than patients with normal CoW which may suggest that BCVI screening across all patients with a head/neck injury may improve the simultaneous detection of CoW and BCVIs. When screening for BCVI, scans including both the head and neck are superior to a single region in detection of concomitant CoW anomalies. Worsened outcomes (strokes, ICH, and clinically significant bleeding before antithrombotic initiation) were observed for patients with CoW anomalies when compared to those with a normal CoW. Those with a CoW anomaly experienced strokes at a higher rate than patients with normal CoW anatomy specifically when antithrombotic therapy was interrupted. This emphasizes the need for stringent antithrombotic therapy regimens among patients with CoW anomalies and may suggest that patients CoW anomalies would benefit from more varying treatment, highlighting the need to include the CoW anatomy when scanning for BCVI. LEVEL OF EVIDENCE: Level III, Prognostic/Epidemiological.

Genetic Screening-Emerging Issues.

In many countries, some form of genetic screening is offered to all or part of the population, either in the form of well-organized screening programs or in a less formalized way. Screening can be offered at different phases of life, such as preconception, prenatal, neonatal and later in life. Screening should only be offered if the advantages outweigh the disadvantages. Technical innovations in testing and treatment are driving changes in the field of prenatal and neonatal screening, where many jurisdictions have organized population-based screening programs. As a result, a greater number and wider range of conditions are being added to the programs, which can benefit couples' reproductive autonomy (preconception and prenatal screening) and improve early diagnosis to prevent irreversible health damage in children (neonatal screening) and in adults (cancer and cascade screening). While many developments in screening are technology-driven, citizens may also express a demand for innovation in screening, as was the case with non-invasive prenatal testing. Relatively new emerging issues for genetic screening, especially if testing is performed using DNA sequencing, relate to organization, data storage and interpretation, benefit-harm ratio and distributive justice, information provision and follow-up, all connected to acceptability in current healthcare systems.

Characteristics of lung cancer screening eligible population in the US and prediction of the eligibility with simplified criteria.

Background: In 2021, updates to the lung cancer screening (LCS) guidelines extended the eligibility to include younger individuals and those with lower lifetime smoking intensity. A significant challenge in the LCS implementation is identifying eligible individuals because lifetime smoking intensity, a key criterion of current guidelines, is typically unavailable in electronic health records and difficult to assess accurately. This study aimed to (I) examine the characteristics of the eligible population in the US based on current guidelines and (II) evaluate the performance of five simplified criteria as alternative tools for predicting LCS eligibility. Methods: National Health and Nutrition Examination Survey (NHANES) 2013-2018 data were used. Five simplified criteria were: (I) ever smoker, defined as an individual with any positive smoking history; (II) current or former smoker, an individual with any positive smoking history or who quit smoking within 15 years; (III) current smoker, an individual currently smoking; (IV) current smoker, an individual currently smoking >0.5 packs per day (ppd); (V) current smoker, a person currently smoking >1 ppd. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. The complex survey design was considered. Results: About 16.70 million individuals (representing 16.01% of population aged 50-80 years) were eligible for LCS in the US. The percentage of LCS eligibility was higher among people who were younger, male, non-Hispanic White, less educated, single, not insured, with poorer health status and lower socioeconomic status. Except for the criterion of current smoker with >1 ppd having low sensitivity (0.08), other criteria had sensitivity ranging between 0.45 and 1.00. The accuracy of the five criteria used ranged between 0.70 and 0.91. Conclusions: Individuals with less favorable social and clinical characteristics have higher chances of being eligible for LCS, potentially amplifying disparities in LCS utilization. Simplified criteria can be used as prescreening tools to identify target populations, which could facilitate LCS implementation at the population level.