The full report is titled “Screening for Abdominal Aortic Aneurysm: U.S. Preventive Services Task Force Recommendation Statement.” It is in the 19 August 2014 issue of Annals of Internal Medicine (volume 161, pages 280-289). The author is M.L. LeFevre, on behalf of the U.S. Preventive Services Task Force.
Ahmad K Rahal, Ayesha Z Zuberi, Robert G Badgett
KU School of Medicine–Wichita
July 11, 2014
Cost of screening for abdominal aortic aneurysm may be less than expected
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.
Screening for Abdominal Aortic Aneurysm: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2014;161:I–26. doi: https://doi.org/10.7326/P14-9028
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Published: Ann Intern Med. 2014;161(4):I-26.
Emergency Medicine, Prevention/Screening.
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