ABSTRACT
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, with a 5-year overall survival rate of 10%. In November 2018, NCCN recommended that all patients with PDAC receive genetic counseling (GC) and germline testing regardless of family history. We hypothesized that patients with PDAC were more likely to be referred for testing after this change to the guidelines, regardless of presumed predictive factors, and that compliance would be further improved following the implementation of a hereditary cancer clinic (HCC). METHODS: We conducted a single-institution retrospective analysis of patients diagnosed with PDAC from June 2017 through December 2021 at University of California, Irvine. We compared rates of genetics referral among patients in different diagnostic eras: the 18-month period before the NCCN Guideline change (pre-NCCN era: June 2017 through November 2018), 14 months following the change (post-NCCN era: December 2018 through January 2020), and 18 months after the creation of an HCC (HCC era: June 2020 through December 2021). Family and personal cancer history, genetics referral patterns, and results of GC were recorded. Data were compared using chi-square, Fisher exact, and multivariate analyses. RESULTS: A total of 335 patients were treated for PDAC (123 pre-NCCN, 109 post-NCCN, and 103 HCC) at University of California, Irvine. Demographics across groups were comparable. Prior to the guideline changes, 30% were referred to GC compared with 54.7% in the post-NCCN era. After the implementation of the HCC, 77.4% were referred to GC (P<.0001). The odds ratio (OR) for referral to GC among patients with a positive family history of cancer progressively decreased following the change (pre-NCCN era: OR, 11.90 [95% CI, 3.00-80.14]; post-NCCN era: OR, 3.39 [95% CI, 1.13-10.76]; HCC era: OR, 3.11 [95% CI, 0.95-10.16]). CONCLUSIONS: The 2018 updates to the NCCN Guidelines for PDAC recommending germline testing for all patients with PDAC significantly increased GC referral rates at our academic medical center. Implementation of an HCC further boosted compliance with guidelines.
Subject(s)
Genetic Testing , Germ-Line Mutation , Guideline Adherence , Pancreatic Neoplasms , Humans , Pancreatic Neoplasms/genetics , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/therapy , Female , Male , Middle Aged , Genetic Testing/standards , Genetic Testing/methods , Guideline Adherence/statistics & numerical data , Retrospective Studies , Aged , Adult , Carcinoma, Pancreatic Ductal/genetics , Carcinoma, Pancreatic Ductal/diagnosis , Carcinoma, Pancreatic Ductal/therapy , Genetic Predisposition to Disease , Genetic Counseling/statistics & numerical data , Referral and Consultation/statistics & numerical data , Referral and Consultation/standards , Practice Guidelines as TopicABSTRACT
Acute compartment syndrome (ACS) is a surgical emergency which requires prompt identification and intervention to prevent irreversible tissue damage. Here we present the case of a 64-year-old male with lower extremity tenderness following a crush injury. This patient presented to the emergency department (ED) more than 12 hours after the initial incident occurred and was found to have a firm right calf with decreased sensation and absent distal pulses on his right leg. The patient's outer compartment pressure measured 32 mmHg. Because these findings were concerning for acute compartment syndrome, emergent fasciotomies of the four compartments of the lower right leg were performed with improvement in neuromuscular compromise. Early identification of the condition permitted a prompt recovery for the patient who was discharged home on day five. This case report reviews the clinical presentation and interventional modalities and aims to provide new images to help visualize a diagnosis of ACS. Topics: Acute compartment syndrome, fasciotomy, intramuscular pressure.