Michael L. LeFevre, MD, MSPH; on behalf of the U.S. Preventive Services Task Force *
Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Financial Support: The USPSTF is an independent, voluntary body. The U.S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF.
Disclosures: Dr. Owens reports support from the Agency for Healthcare Research and Quality during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Authors followed the policy regarding conflicts of interest described at www.uspreventive servicestaskforce.org/methods.htm. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1204.
Requests for Single Reprints: Reprints are available from the USPSTF Web site (www.uspreventiveservicestaskforce.org).
Update of the 2005 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for abdominal aortic aneurysm (AAA).
The USPSTF commissioned a systematic review that assessed the evidence on the benefits and harms of screening for AAA and strategies for managing small (3.0 to 5.4 cm) screen-detected AAAs.
These recommendations apply to asymptomatic adults aged 50 years or older.
The USPSTF recommends 1-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked. (B recommendation)
The USPSTF recommends that clinicians selectively offer screening for AAA in men aged 65 to 75 years who have never smoked. (C recommendation)
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA in women aged 65 to 75 years who have ever smoked. (I statement)
The USPSTF recommends against routine screening for AAA in women who have never smoked. (D recommendation)
Screening for abdominal aortic aneurysm: clinical summary of U.S. Preventive Services Task Force recommendation.
* “Ever smoked” is defined as having smoked at least 100 cigarettes during a lifetime.
Appendix Table 1. What the USPSTF Grades Mean and Suggestions for Practice
Appendix Table 2. USPSTF Levels of Certainty Regarding Net Benefit
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Ahmad K Rahal, Ayesha Z Zuberi, Robert G Badgett
KU School of Medicine–Wichita
July 22, 2014
The updated United States Preventive Services Task Force (USPSTF) guidelines recommend screening men aged 65 to 75 who have ever smoked for abdominal aortic aneurysm (AAA) (1). In designing the screening process in our internal medicine clinic, we speculated whether Atul Gawande’s observation of the frequency of tomography in a community would warrant querying regional health care providers for existing abdominal imaging prior to undergoing screening (2). This could reduce the cost of mass screening.To assess the prevalence of existing imaging which would qualify as screening, we executed a review of our clinic’s electronic health records (EHR) of patients who met the USPSTF criteria for AAA screening: males aged 65 to 75 ever-smokers. In addition, we reviewed EHR of the same patients at our two major regional hospitals to identify incidental imaging, specifically computed tomography (CT) and magnetic resonance imaging (MRI) with specific mention of the aorta, as well as the standard screening ultrasound. We randomly selected 83 patients for review at our resident clinic. Only one patient had properly documented screening in the clinic’s EHR. Hospital records indicated an additional 43% of patients had incidental imaging, but 20% of these radiology reports did not comment on the aorta.We found a high rate of existing abdominal imaging after review of regional hospital records. While these numbers could be inflated due to fragmented health care in Wichita, the results are high enough to suggest clinics should consider searching for pre-existing diagnostic imaging. These results suggest that better documentation of the aorta in older adults by radiologists and better exchange of patient information between providers would improve cost as well as quality of care.References:1. LeFevre ML. Screening for Abdominal Aortic Aneurysm: U.S. Preventive ServicesTask Force Recommendation Statement. Ann Intern Med. 2014 [Epub ahead of print] PMID: 24957320.2. Gawande, A. How do we heal medicine? 2012. Accessed at TED at https://www.ted.com/talks/atul_gawande_how_do_we_heal_medicine on 07/11/2014.
LeFevre ML, on behalf of the U.S. Preventive Services Task Force. Screening for Abdominal Aortic Aneurysm: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. ;161:281–290. doi: 10.7326/M14-1204
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Published: Ann Intern Med. 2014;161(4):281-290.
Emergency Medicine, Guidelines, Prevention/Screening.
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