RESUMEN
In the latest ESUR contrast media guidelines, standard prophylaxis is no longer recommended for patients with moderate chronic kidney disease (CKD). In the absence of solid evidence, guideline updates are often based on indirect evidence and expert opinion. Likewise, evidence supporting the withdrawal of standard prophylaxis in moderate CKD patients was scarce and mostly indirect, but did include one randomised controlled trial evaluating guideline-recommended standard prophylactic intravenous hydration against a group receiving no prophylaxis (A MAastricht Contrast-Induced Nephropathy Guideline (AMACING) trial). Since then, benefits of the updated guideline recommendation for patient and hospital burden have been numerated and were shown to be substantial. The current special report provides data on long-term safety from the AMACING randomised controlled trial. KEY POINTS: ⢠In the latest version of ESUR clinical practice guidelines for safe use of contrast media, standard prophylaxis is no longer recommended for patients with moderate chronic kidney disease. ⢠Benefits of this change in recommendations for patient and hospital burden have been numerated. The current report provides data on long-term safety from the AMACING randomised controlled trial. ⢠No disadvantage of withholding prophylaxis could be discerned. Results suggest that, in this population, underlying disease is more relevant for survival and prognosis than contrast administration itself.
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Medios de Contraste , Insuficiencia Renal Crónica , Humanos , Tasa de Filtración Glomerular , Medios de Contraste/efectos adversos , Factores de Riesgo , Fluidoterapia/métodos , Insuficiencia Renal Crónica/complicacionesAsunto(s)
Antineoplásicos , Carcinoma Basocelular , Neoplasias Cutáneas , Aminoquinolinas/uso terapéutico , Antineoplásicos/uso terapéutico , Carcinoma Basocelular/tratamiento farmacológico , Humanos , Imiquimod/uso terapéutico , Pronóstico , Neoplasias Cutáneas/tratamiento farmacológico , Insuficiencia del Tratamiento , Resultado del TratamientoAsunto(s)
Carcinoma Basocelular , Neoplasias Cutáneas , Carcinoma Basocelular/diagnóstico por imagen , Carcinoma Basocelular/patología , Carcinoma Basocelular/cirugía , Humanos , Márgenes de Escisión , Cirugía de Mohs/métodos , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Tomografía de Coherencia Óptica/métodosRESUMEN
Contrast-enhanced mammography (CEM) has shown to be superior to full-field digital mammography (FFDM), but current results are dominated by studies performed on systems by one vendor. Information on diagnostic accuracy of other CEM systems is limited. Therefore, we aimed to evaluate the diagnostic performance of CEM on an alternative vendor's system. We included all patients who underwent CEM in one hospital in 2019, except those with missing data or in whom CEM was used as response monitoring tool. Three experienced breast radiologists scored the low-energy images using the BI-RADS classification. Next, the complete CEM exams were scored similarly. Histopathological results or a minimum of one year follow-up were used as reference standard. Diagnostic performance and AUC were calculated and compared between low-energy images and the complete CEM examination, for all readers independently as well as combined. Breast cancer was diagnosed in 23.0% of the patients (35/152). Compared to low-energy images, overall CEM sensitivity increased from 74.3 to 87.6% (p < 0.0001), specificity from 87.8 to 94.6% (p = 0.0146). AUC increased from 0.872 to 0.957 (p = 0.0001). Performing CEM on the system tested, showed that, similar to earlier studies mainly performed on another vendor's systems, both sensitivity and specificity improved when compared to FFDM.
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Neoplasias de la Mama/diagnóstico , Mama/diagnóstico por imagen , Mama/patología , Mamografía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/etiología , Toma de Decisiones Clínicas , Medios de Contraste , Manejo de la Enfermedad , Femenino , Humanos , Imagen por Resonancia Magnética , Mamografía/normas , Tamizaje Masivo , Persona de Mediana Edad , Curva ROC , Intensificación de Imagen Radiográfica , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: The purpose of this study was to investigate the prevalence of ypN+ status according to ypT category in patients with locally advanced rectal cancer treated with chemoradiotherapy and total mesorectal excision, and to assess the impact of ypN+ on disease recurrence and survival by pooled analysis of individual-patient data. METHODS: Individual-patient data from 10 studies of chemoradiotherapy for rectal cancer were included. Pooled rates of ypN+ disease were calculated with 95 per cent confidence interval for each ypT category. Kaplan-Meier and Cox regression analyses were undertaken to assess influence of ypN status on 5-year disease-free survival (DFS) and overall survival (OS). RESULTS: Data on 1898 patients were included in the study. Median follow-up was 50 (range 0-219) months. The pooled rate of ypN+ disease was 7 per cent for ypT0, 12 per cent for ypT1, 17 per cent for ypT2, 40 per cent for ypT3, and 46 per cent for ypT4 tumours. Patients with ypN+ disease had lower 5-year DFS and OS (46.2 and 63.4 per cent respectively) than patients with ypN0 tumours (74.5 and 83.2 per cent) (P < 0.001). Cox regression analyses showed ypN+ status to be an independent predictor of recurrence and death. CONCLUSION: Risk of nodal metastases (ypN+) after chemoradiotherapy increases with advancing ypT category and needs to be considered if an organ-preserving strategy is contemplated.
When patients are diagnosed with rectal cancer and the tumour grows beyond the rectal wall there is a high risk that the tumour has spread to nearby lymph nodes. This study showed that this relationship between tumour invasion depth and lymph node involvement is similar after treatment with (chemo)radiotherapy. Patients who have tumour cells remaining in the lymph nodes after (chemo) radiotherapy have a worse prognosis than patients who do not have cancer cells remaining in the lymph nodes. When an organ-preserving treatment is considered as an alternative therapy, this should be kept in mind during patient counselling.
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Ganglios Linfáticos/patología , Metástasis Linfática , Neoplasias del Recto/patología , Neoplasias del Recto/terapia , Anciano , Anciano de 80 o más Años , Quimioradioterapia Adyuvante , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia , Proctectomía , Neoplasias del Recto/cirugía , Análisis de RegresiónRESUMEN
OBJECTIVE: Guidelines on safe use of iodinated contrast material recommend intravenous prophylactic hydration to prevent post-contrast adverse (renal) effects. Recently, guidelines have been updated and standard prophylaxis is no longer recommended for the majority of patients. The current study aims to evaluate the consequences for clinical practice of the updated guidelines in terms of complications, hospitalisations, and costs. METHODS: The Contrast-Induced Nephropathy After Reduction of the prophylaxis Threshold (CINART) project is a retrospective observational study. All elective procedures with intravascular iodinated contrast administration at Maastricht University Medical Centre (UMC+) in patients aged > 18 years, formerly eligible for prophylaxis (eGFR 30-44 ml/min/1.73 m2 or eGFR 45-59 ml/min/1.73 m2 in combination with diabetes or > 1 predefined risk factor), and currently eligible for prophylaxis (eGFR < 30 ml/min/1.73 m2) were included. Data were used to calculate relative reductions in complications, hospitalisations, and costs associated with standard prophylactic intravenous hydration. CINART is registered with Clinicaltrials.gov: NCT03227835. RESULTS: Between July 1, 2017, and July 1, 2018, 1992 elective procedures with intravascular iodinated contrast in patients formerly and currently eligible for prophylaxis were identified: 1808 in patients formerly eligible for prophylaxis and 184 in patients currently eligible for prophylaxis. At Maastricht UMC+, guideline updates led to large relative reductions in numbers of complications of prophylaxis (e.g. symptomatic heart failure; - 89%), extra hospitalisations (- 93%), and costs (- 91%). CONCLUSION: Guideline updates have had a demonstrable impact on daily clinical practice benefiting patient, hospital, and health care budgets. Clinical practice varies between institutions and countries; therefore, a local estimation model is provided with which local impact on costs, hospitalisations, and complications can be calculated. KEY POINTS: ⢠Clinical practice guidelines recommend prophylactic intravenous hydration to prevent post-contrast adverse outcomes such as contrast-induced acute kidney injury. ⢠Clinical practice guidelines have recently been updated, and standard prophylaxis is no longer recommended for the majority of patients. ⢠The guideline updates have a large impact on daily clinical practice: relative reductions at Maastricht UMC+ were - 89% prophylaxis complications, - 93% hospitalisations, and - 91% costs, and similar reductions are expected for Dutch and adherent European medical centres.
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Medios de Contraste/administración & dosificación , Medios de Contraste/efectos adversos , Radioisótopos de Yodo/administración & dosificación , Radioisótopos de Yodo/efectos adversos , Guías de Práctica Clínica como Asunto , Lesión Renal Aguda/inducido químicamente , Administración Intravenosa , Adolescente , Adulto , Anciano , Medios de Contraste/economía , Fluidoterapia/economía , Fluidoterapia/métodos , Tasa de Filtración Glomerular , Costos de Hospital , Hospitalización/economía , Humanos , Radioisótopos de Yodo/economía , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Actinic keratosis (AK) is a common premalignant skin condition that might have the ability to progress into squamous cell carcinoma. Due to the high incidence of AK, treatment of this disease significantly impacts healthcare spending. OBJECTIVES: To determine which commonly prescribed field-directed treatment is the most cost-effective, when comparing 5-fluorouracil (5-FU) 5%, imiquimod (IMQ) 5%, ingenol mebutate (IM) 0·015% and methyl aminolaevulinate photodynamic therapy (MAL-PDT) for AK in the head and neck region. METHODS: We performed an economic evaluation from a healthcare perspective. Data were collected alongside a single-blinded, prospective, multicentre randomized controlled trial with 624 participants in the Netherlands. The outcome measure was expressed as the incremental cost-effectiveness ratio, which is the incremental costs per additional patient with ≥ 75% lesion reduction compared with baseline. This trial was registered at ClinicalTrials.gov, number NCT02281682. RESULTS: The trial showed that 5-FU was the most effective field treatment for AK in the head and neck region. Twelve months post-treatment, the total mean costs for 5-FU were significantly lower (433) than the 728, 775 and 1621 for IMQ, IM and MAL-PDT, respectively. The results showed that 5-FU was a dominant cost-effective treatment (more effective and less expensive) compared with the other treatments, 12 months post-treatment. CONCLUSIONS: Based on these results, we consider 5-FU 5% cream as the first-choice treatment option for multiple AKs in the head and neck area. What's already known about this topic? Due to the increasing incidence of actinic keratosis (AK), the recommended treatment results in a considerable socioeconomic burden for (dermatological) healthcare. Although cost-effectiveness modelling studies have been performed in which different treatments for AK were compared, a prospective clinical trial comparing four frequently prescribed treatments on effectiveness and resource consumption within a time horizon of 12 months has never been conducted. What does this study add? This is the first study examining the cost-effectiveness of 5-fluorouracil 5% cream, imiquimod 5% cream, ingenol mebutate 0·015% gel and methyl aminolaevulinate photodynamic therapy, with data collected in a randomized controlled trial over a time horizon of 12 months. We found that 5-fluorouracil was a dominant cost-effective treatment (more effective and less costly), based on data from the Netherlands. Linked Comment: Steeb et al. Br J Dermatol 2020; 183:612.
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Queratosis Actínica , Fotoquimioterapia , Ácido Aminolevulínico/análogos & derivados , Ácido Aminolevulínico/uso terapéutico , Análisis Costo-Beneficio , Diterpenos , Fluorouracilo/uso terapéutico , Humanos , Imiquimod/uso terapéutico , Queratosis Actínica/tratamiento farmacológico , Países Bajos , Fármacos Fotosensibilizantes/uso terapéutico , Estudios Prospectivos , Resultado del TratamientoRESUMEN
PURPOSE AND BACKGROUND: This study retrospectively compares diagnostic performance of 1.5 T versus 3 T non-echo planar diffusion weighted imaging with or without additional T1 and T2 sequences in the detection of residual and/or recurrent cholesteatoma. METHODS: Patients with clinically suspected recurrent cholesteatoma or postoperative routine survey MR who subsequently underwent surgical procedure were retrospectively included (135 patients, 164 operated ears) from a large database. Patients underwent 1.5 T (128 ears) or 3 T MRI (36 ears), with non-echo planar DWI, T1 and T2 acquisitions. Two radiologists independently reassessed the images. Definitive surgical diagnosis was used as gold standard. Sensitivity, specificity and diagnostic odds ratio were evaluated. RESULTS: According to surgical diagnosis a cholesteatoma was present in 124 of 164 ears, corresponding with a prevalence of 75%. Sensitivity and specificity were lower for 3 T compared to 1.5 T, irrespective of whether additional T1 and T2-weighted sequences were used or not. Diagnostic odds ratios were higher for 1.5 T (34 and 12 for reader 1 and 2, respectively) compared to 3 T (3 and 4 for reader 1 and 2, respectively). Adding T1 and T2 sequences lowers sensitivity but increases specificity. CONCLUSION: Non-epi DWI for the detection of residual/recurrent cholesteatoma is preferably performed on 1.5 T scanners over 3 T. The use of additional sequences regarding detection of cholesteatoma is debatable as it lowers sensitivity but increases specificity. However, these sequences may also be of use in diagnosing complications and planning surgical procedures in some hospitals.
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Colesteatoma del Oído Medio/diagnóstico por imagen , Colesteatoma del Oído Medio/cirugía , Imagen de Difusión por Resonancia Magnética/métodos , Apófisis Mastoides/diagnóstico por imagen , Adolescente , Adulto , Anciano , Niño , Colesteatoma del Oído Medio/patología , Imagen Eco-Planar , Femenino , Humanos , Masculino , Apófisis Mastoides/patología , Persona de Mediana Edad , Países Bajos , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: In the Dutch breast cancer screening program, women recalled with a BI-RADS 0 score are referred for additional imaging, while those with BI-RADS 4/5 scores are also directed to an outpatient breast clinic. Approximately six out of ten women are recalled without being diagnosed with a malignancy. However, these recalls require additional imaging and doctor visits, which result in patient anxiety and increased health care costs. Conventional types of imaging used for additional imaging are full-field digital mammography and tomosynthesis. Contrast-enhanced spectral mammography has proved to have higher sensitivity and specificity than conventional imaging in women recalled from screening. Therefore, the aim is to study if CESM instead of conventional imaging is a more accurate, patient-friendly, and cost-effective strategy in the work-up of women recalled from breast cancer screening. METHODS: This prospective, multicenter, randomized controlled trial will be conducted at four centers and will include 528 patients recalled for suspicious breast lesions from the Dutch breast cancer screening program. Participants are randomized in two groups: (1) standard care using conventional breast imaging techniques as initial imaging after recall versus (2) work-up primarily based on CESM. Written informed consent will be collected prior to study inclusion. The primary outcome is the diagnostic accuracy for detection of breast cancer. Secondary outcomes are numbers of additional diagnostic exams, days until final diagnosis, health care costs, and experienced patient anxiety. DISCUSSION: Based on previously published retrospective studies, we expect to demonstrate in this prospective multicenter randomized controlled trial, that using CESM as a primary work-up tool in women recalled from breast cancer screening is a more accurate, cost-effective, and patient-friendly strategy. TRIAL REGISTRATION: Netherlands Trial Register, NL6413/NTR6589. Registered on 6 July, 2017.
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Neoplasias de la Mama/diagnóstico por imagen , Detección Precoz del Cáncer/métodos , Mamografía/métodos , Ansiedad/psicología , Biopsia con Aguja Fina , Biopsia con Aguja Gruesa , Neoplasias de la Mama/irrigación sanguínea , Medios de Contraste , Análisis Costo-Beneficio , Detección Precoz del Cáncer/economía , Detección Precoz del Cáncer/psicología , Femenino , Costos de la Atención en Salud , Accesibilidad a los Servicios de Salud , Humanos , Imagen por Resonancia Magnética , Mamografía/economía , Mamografía/psicología , Países Bajos , Ultrasonografía MamariaRESUMEN
BACKGROUND: Guidelines recommend screening of high-risk women using breast magnetic resonance imaging (MRI). Contrast-enhanced mammography (CEM) has matured, providing excellent diagnostic accuracy. To lower total radiation dose, evaluation of single-view (1 V) CEM exams might be considered instead of double-view (2 V) readings as an alternative reading strategy in women who cannot undergo MRI. METHODS: This retrospective non-inferiority feasibility study evaluates whether the use of 1 V results in an acceptable sensitivity for detecting breast cancer (non-inferiority margin, - 10%). CEM images from May 2013 to December 2017 were included. 1 V readings were performed by consensus opinion of three radiologists, followed by 2 V readings being performed after 6 weeks. Cases were considered "malignant" if the final BI-RADS score was ≥ 4, enabling calculation of sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Histopathological results or follow-up served as a gold standard. RESULTS: A total of 368 cases were evaluated. Mean follow-up for benign or negative cases was 20.9 months. Sensitivity decreased by 9.6% from 92.9 to 83.3% when only 1 V was used for evaluation (p < 0.001). The lower limit of the 90% confidence interval around the difference in sensitivity between 1 V and 2 V readings was - 15% and lies below the predefined non-inferiority margin of - 10%. Hence, non-inferiority of 1 V to 2 V reading cannot be concluded. AUC for 1 V was significantly lower, 0.861 versus 0.899 for 2 V (p = 0.0174). CONCLUSION: Non-inferiority of 1 V evaluations as an alternative reading strategy to standard 2 V evaluations could not be concluded. 1 V evaluations had lower diagnostic performance compared with 2 V evaluations. KEY POINTS: ⢠To lower radiation exposure used in contrast-enhanced mammography, we studied a hypothetical alternative strategy: single-view readings (1 V) versus (standard) double-view readings (2 V). ⢠Based on our predefined margin of - 10%, non-inferiority of 1 V could not be concluded. ⢠1 V evaluation is not recommended as an alternative reading strategy to lower CEM-related radiation exposure.
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Neoplasias de la Mama/diagnóstico , Mama/patología , Medios de Contraste/farmacología , Imagen por Resonancia Magnética/métodos , Mamografía/métodos , Anciano , Estudios de Factibilidad , Femenino , Humanos , Persona de Mediana Edad , Curva ROC , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
INTRODUCTION: Imaging findings can be affected by histopathological characteristics, such as breast cancer subtypes. The aim was to determine whether the diagnostic performance, in particular negative predictive value (NPV), of axillary US differs per subtype of breast cancer. METHODS: All patients diagnosed between 2008 and 2016 in our hospital with primary invasive breast cancer and an axillary US prior to axillary surgery were included. Histopathology of axillary surgery specimens served as gold standard. The NPV, sensitivity, specificity, positive predictive value (PPV) and accuracy of the axillary US were determined for the overall population and for each subtype (ER+/PR+HER2-,HER2+, triple negative tumors). The Chi-square test was used to determine the difference in diagnostic performance parameters between the subtypes. RESULTS: A total of 1094 breast cancer patients were included. Of these, 35 were diagnosed with bilateral breast cancer, resulting in 1129 cancer cases. Most common subtype was ER+/PR+HER2- in 858 cases (76.0%), followed by 150 cases of HER2+ tumors (13.3%) and 121 cases of triple negative tumors (10.7%). Sensitivity, specificity and accuracy of axillary US did not significantly differ between the subtypes. There was a significant difference for NPV between triple negative tumors and HER2+ tumors (90.3% vs. 80.2%, p = 0.05) and between HER2+ and ER/PR+HER2- tumors (80.2% vs. 87.2%, p = 0.04). CONCLUSION: There was no significant difference in the diagnostic performance of axillary US between the subtypes, except for NPV. This was highest in triple negative subtype and lowest in HER2+ tumors. This can be explained by the difference in prevalence of axillary lymph node metastases in our cohort.
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Ganglios Linfáticos/diagnóstico por imagen , Neoplasias de la Mama Triple Negativas/metabolismo , Neoplasias de la Mama Triple Negativas/patología , Ultrasonografía , Neoplasias de Mama Unilaterales/metabolismo , Neoplasias de Mama Unilaterales/patología , Adulto , Anciano , Anciano de 80 o más Años , Reacciones Falso Negativas , Femenino , Humanos , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Metástasis Linfática , Persona de Mediana Edad , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Receptor ErbB-2/metabolismo , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Estudios Retrospectivos , Biopsia del Ganglio Linfático Centinela , Adulto JovenAsunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Calcinosis/diagnóstico por imagen , Medios de Contraste , Mamografía/métodos , Cuidados Preoperatorios/métodos , Intensificación de Imagen Radiográfica/métodos , Anciano , Mama/diagnóstico por imagen , Mama/patología , Mama/cirugía , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Calcinosis/patología , Femenino , Humanos , Mastectomía/métodos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadAsunto(s)
Carcinoma Basocelular/cirugía , Técnicas de Preparación Histocitológica , Márgenes de Escisión , Recurrencia Local de Neoplasia/patología , Neoplasias Cutáneas/cirugía , Carcinoma Basocelular/patología , Humanos , Recurrencia Local de Neoplasia/prevención & control , Estudios Retrospectivos , Piel/patología , Neoplasias Cutáneas/patologíaRESUMEN
BACKGROUND: We evaluated the characteristics of a novel text message system notifying citizen rescuers in cases of out-of-hospital circulatory arrest (OHCA) in the Dutch province of Limburg, including their relation to incidence and survival. METHODS AND RESULTS: The study area comprised 2,153â¯km2 (831â¯mi2) with 1.12â¯mio. inhabitants. During the 2year study period approximately 9,000 volunteers were registered, about 60% male, 59% with no experience in actual resuscitation, and 27.4% healthcare professionals. The system was not activated in 557 of 1,085 (51.3%) OHCAs, frequently because there was no resuscitation setting present yet at the time of the emergency call. Rescuers were notified on 1,076 occasions, with no resuscitation setting being present in 548 of 1,076 (50.9%) notifications. OHCA incidence rates were 67 per 100,000 inhabitants per year, 95 per 100,000 men and 39 per 100,000 women standardised for age with the European Standard Population. The mean number of notifications per volunteer was 1.3 times per year. Higher volunteer density was related to increased survival if at least one volunteer attended the cardiac arrest. If the density exceeded 0.75%, survival increased to 34.8% compared to 20.6% at a density below 0.25%. CONCLUSION: In about half of OHCAs needing resuscitation the system was activated and in approximately half of the notifications resuscitation proved to be justified. Volunteers are notified 1.3 times per year on average. Survival was related to volunteer density, suggesting that further improvement can be achieved by increasing the number of citizen rescuers.
RESUMEN
INTRODUCTION: The bleeding assessment tool (BAT) has been developed to standardize and interpret bleeding history for mild bleeding disorders. However, a critical appraisal addressing the quality and results of validation studies is lacking. AIM: We performed a systematic review of diagnostic studies assessing the performance of the BAT in patients referred for evaluation of bleeding symptoms. METHODS: The electronic database PubMed was searched from inception through July 27, 2017. Eligible publications were original studies that assessed and validated the diagnostic accuracy of bleeding questionnaires for identification of adults with mild bleeding disorders. For each study, sensitivity, specificity and diagnostic odds ratio (DOR) were calculated. Quality was assessed using the Quality Assessment of Diagnostic studies-2 tool. To assess the influence of specific study characteristics on DOR, univariate meta-regression analyses were performed. RESULTS: Nine studies were included. Five studies investigating the ISTH-BAT or other bleeding questionnaires had a moderate to low DOR. Four studies investigating Vicenza-based BATs had a high DOR, with high specificity (>90%) and sensitivity of 59%-85%. Study characteristics such as case-control design, retrospective data collection and differences in reference standard were associated with optimistic estimates of diagnostic performance. Three of four studies with a high DOR had these study characteristics. Studies with good methodological quality mainly had a low DOR. CONCLUSION: The main advantage of the BAT is that it offers a complete and structured interview. However, the BAT is of limited diagnostic value to the workup of patients referred for bleeding evaluation in clinical practice.
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Trastornos de la Coagulación Sanguínea/diagnóstico , Humanos , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Encuestas y CuestionariosRESUMEN
Correction to:Neth Heart J 2017 https://doi.org/10.1007/s12471-017-1057-1 In the version of the article originally published online, there was an error in the last section of the Discussion. It is stated that 'In 42% of the OHCAs a volunteer alert would have been appropriate, but the alert system .