Craig Fleming, MD; Evelyn P. Whitlock, MD, MPH; Tracy L. Beil, MS; Frank A. Lederle, MD
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the U.S. Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Acknowledgments: The authors thank Daphne Plaut, MLS, Paula Smith, RN, BSN, Rochelle Fu, PhD, and the reviewers of the full evidence synthesis for their contributions to this project. Ned Calonge, MD, MPH, Russ Harris, MD, MPH, Mark Johnson, MD, MPH, Diana Petitti, MD, MPH, and Steven Teutsch, MD, MPH, provided critical oversight and assistance for the USPSTF.
Grant Support: This study was conducted by the Oregon Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality, Rockville, Maryland (Contract 290-02-0024, Task Order 2).
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Reprints are available from the Agency for Healthcare Research and Quality Web site (www.preventiveservices.ahrq.gov) and through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295; e-mail, email@example.com).
Current Author Addresses: Drs. Fleming and Whitlock and Ms. Beil: Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227.
Dr. Lederle: VA Medical Center, One Veterans Drive, Minneapolis, MN 55417.
While the prognosis for abdominal aortic aneurysm (AAA) rupture is poor, ultrasound imaging is an accurate and reliable test for detecting AAAs before rupture.
To examine the benefits and harms of population-based AAA screening.
MEDLINE (1994 to July 2004) supplemented by the Cochrane Library, a reference list of retrieved articles, and expert suggestions.
Randomized trials of AAA population screening, population studies of AAA risk factors, and data on adverse screening and treatment events from randomized trials and cohort studies.
All studies were reviewed, abstracted, and rated for quality by using predefined criteria.
The authors identified 4 population-based randomized, controlled trials of AAA screening in men 65 years of age and older. On the basis of meta-analysis, an invitation to attend screening was associated with a significant reduction in AAA-related mortality (odds ratio, 0.57 [95% CI, 0.45 to 0.74]). A meta-analysis of 3 trials revealed no significant difference in all-cause mortality (odds ratio, 0.98 [CI, 0.95 to 1.02]). No significant reduction in AAA-related mortality was found in 1 study of AAA screening in women. Screening does not appear to be associated with significant physical or psychological harms. Major treatment harms include an operative mortality rate of 2% to 6% and significant risk for major complications.
The population screening studies focused on men and provided no information on racial or ethnic groups. No information was available on uninvited control group characteristics, so the importance of risk factors such as tobacco use or family history could not be assessed. Since all trials were conducted in countries other than the United States, generalizability to the U.S. population is uncertain.
For men age 65 to 75 years, an invitation to attend AAA screening reduces AAA-related mortality.
Table 1. Characteristics of Screening Trials for Abdominal Aortic Aneurysm
Meta-analysis of mortality associated with abdominal aortic aneurysms in the abdominal aortic aneurysm screening trials.
Meta-analysis of all-cause mortality in the abdominal aortic aneurysm screening trials.
Prevalence of abdominal aortic aneurysms (AAAs) greater than 3.0 cm, according to age and smoking history.
Primary care screening for abdominal aortic aneurysms (AAAs): analytic framework.
Trial flow diagram of studies evaluated for inclusion in each key question (KQ).
Table 2. Five-Year Outcomes of Abdominal Aortic Aneurysm Screening by Smoking History in a Cohort of 100 000 Men 65 to 74 Years of Age
Appendix Table. Formulas for Calculations in Outcomes Table 2
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Craig Fleming, Evelyn P. Whitlock, Tracy L. Beil, Frank A. Lederle. Screening for Abdominal Aortic Aneurysm: A Best-Evidence Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2005;142:203–211. doi: 10.7326/0003-4819-142-3-200502010-00012
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Published: Ann Intern Med. 2005;142(3):203-211.
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