1
|
Tuli A, Gadodia R, Meda N, Arar T, Gautam M, Zaghlol L, Rasheed AD, Kallur A, Agrawal R, Govindu R, Pristoop R, Chai C, Ammar H. Impact of Preoperative Echocardiograms on In-Hospital Outcomes of Patients Undergoing Surgical Hip Fracture Repair and Their Clinical Appropriateness. South Med J 2023; 116:420-426. [PMID: 37137478 DOI: 10.14423/smj.0000000000001558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Preoperative transthoracic echocardiograms (TTE) before hip fracture repairs are controversial. This study aimed to quantify the frequency of ordering TTE, the appropriateness of testing based on current guidelines, and the impact of TTE on in-hospital morbidity and mortality outcomes. METHODS This retrospective chart review of adult patients admitted with hip fracture compared the length of stay (LOS), time to surgery, in-hospital mortality, and postoperative complications between TTE and non-TTE groups. TTE patients were risk stratified using the Revised Cardiac Risk Index (RCRI) to compare TTE indication according to current guidelines. RESULTS Of the 490 patients included in this study, 15% received preoperative TTE. The median LOS of the TTE and non-TTE groups was 7.0 and 5.0 d, respectively, whereas the median time to surgery was 34 and 14 h, respectively. The odds of in-hospital mortality remained significantly higher in the TTE group after adjusting for RCRI but not when adjusted for the Charlson Comorbidity Index. Significantly more patients in the TTE groups had postoperative heart failure and up triage in the intensive care unit. Furthermore, 48% of patients with an RCRI score of 0 received preoperative TTE, with cardiac history as the most typical indication. TTE changed perioperative management in 9% of patients. CONCLUSIONS Patients subjected to TTE before hip fracture surgery had a longer LOS and time to surgery, with higher mortality and intensive care unit up triage rates. TTE evaluations were typically conducted for inappropriate indications, which rarely made meaningful changes to patient management.
Collapse
Affiliation(s)
- Aakash Tuli
- From Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Ritika Gadodia
- From Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Namratha Meda
- From Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Tareq Arar
- From Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Monika Gautam
- From Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Louay Zaghlol
- From Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Ahmed D Rasheed
- From Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Akhil Kallur
- From Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Rajeev Agrawal
- MedStar Health Research Institute, Hyattsville, Maryland
| | - Rukma Govindu
- Internal Medicine, University of Texas McGovern Medical School, Houston
| | - Raphael Pristoop
- From Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Christina Chai
- From Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Hussam Ammar
- From Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC
| |
Collapse
|
2
|
Govindu R, Pitre T, Ammar H. A binding problem in a compliant patient - an unintended consequence of Kayexalate. Am J Med Sci 2021; 363:202-203. [PMID: 34425069 DOI: 10.1016/j.amjms.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/16/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Rukma Govindu
- Internal Medicine Department, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Toni Pitre
- Clinical Pharmacy, Ochsner Health System, New Orleans, LA, USA
| | - Hussam Ammar
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, USA
| |
Collapse
|
3
|
Stingo FE, Sallam T, Govindu R, Ammar H. It Is Not Pneumonia! A Case of Unilateral Pulmonary Edema. Am J Med 2021; 134:e38-e39. [PMID: 32712144 DOI: 10.1016/j.amjmed.2020.05.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Facundo E Stingo
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC
| | - Tariq Sallam
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC
| | - Rukma Govindu
- Internal Medicine Department, University of Texas Health Science Center at Houston, Houston
| | - Hussam Ammar
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC.
| |
Collapse
|
4
|
Ahn K, Govindu R. A Rash Diagnosis: A Teachable Moment. Am J Med 2020; 133:e108-e109. [PMID: 31622582 DOI: 10.1016/j.amjmed.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Kristopher Ahn
- Department of Internal Medicine-Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston.
| | - Rukma Govindu
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston
| |
Collapse
|
5
|
Govindu R, Ammar H. Thoracic Deformity and Acro-Osteolysis in Severe Renal Osteodystrophy. Mayo Clin Proc 2019; 94:2358-2359. [PMID: 31685157 DOI: 10.1016/j.mayocp.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 08/05/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Rukma Govindu
- University of Texas Health Science Center at Houston, Houston, TX.
| | | |
Collapse
|
6
|
Madanchi N, Govindu R, Ammar H. A Case Report of Afebrile Malaria. Am J Med 2019; 132:e739-e740. [PMID: 31100283 DOI: 10.1016/j.amjmed.2019.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Nima Madanchi
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC
| | - Rukma Govindu
- Internal Medicine Department, University of Texas Health Science Center at Houston
| | - Hussam Ammar
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC.
| |
Collapse
|
7
|
Ammar H, Ohri C, Hajouli S, Kulkarni S, Tefera E, Fouda R, Govindu R. Prevalence and Predictors of Pulmonary Embolism in Hospitalized Patients with Syncope. South Med J 2019; 112:421-427. [PMID: 31375838 DOI: 10.14423/smj.0000000000001009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Approximately one in six patients hospitalized with syncope have pulmonary embolism (PE), according to the PE in Syncope Italian Trial study. Subsequent studies using administrative data have reported a PE prevalence of <3%. The aim of the study was to determine the prevalence and predictors of PE in hospitalized patients with syncope. METHODS We retrospectively reviewed the records of patients who were hospitalized in the MedStar Washington Hospital Center between May 1, 2015 and June 30, 2017 with deep venous thrombosis, PE, and syncope. Only patients who presented to the emergency department with syncope were included in the final analysis. PE was diagnosed by either positive computed tomographic angiography or a high-probability ventilation-perfusion scan. Univariate and multivariate logistic regressions were used to assess the associations between clinical variables and the diagnosis of PE in patients with syncope. RESULTS Of the 408 patients hospitalized with syncope (mean age, 67.5 years; 51% men [N = 208]), 25 (6%) had a diagnosis of PE. Elevated troponin levels (odds ratio 6.6, 95% confidence interval 1.9-22.9) and a dilated right ventricle on echocardiogram (odds ratio 6.9, 95% confidence interval 2.0-23.6) were independently associated with the diagnosis of PE. Age, active cancer, and history of deep venous thrombosis were not associated with the diagnosis of PE. CONCLUSIONS The prevalence of PE in this study is approximately one-third of the reported prevalence in the PE in Syncope Italian Trial study and almost three times the value reported in administrative data-based studies. PE should be suspected in patients with syncope and elevated troponin levels or a dilated right ventricle on echocardiogram.
Collapse
Affiliation(s)
- Hussam Ammar
- From the Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, MedStar Health Research Institute, Hyattsville, Maryland, George Eliot Hospital NHS Trust, Nuneaton, United Kingdom, and the Internal Medicine Department, University of Texas Health Science Center at Houston, Houston
| | - Chaand Ohri
- From the Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, MedStar Health Research Institute, Hyattsville, Maryland, George Eliot Hospital NHS Trust, Nuneaton, United Kingdom, and the Internal Medicine Department, University of Texas Health Science Center at Houston, Houston
| | - Said Hajouli
- From the Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, MedStar Health Research Institute, Hyattsville, Maryland, George Eliot Hospital NHS Trust, Nuneaton, United Kingdom, and the Internal Medicine Department, University of Texas Health Science Center at Houston, Houston
| | - Shaunak Kulkarni
- From the Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, MedStar Health Research Institute, Hyattsville, Maryland, George Eliot Hospital NHS Trust, Nuneaton, United Kingdom, and the Internal Medicine Department, University of Texas Health Science Center at Houston, Houston
| | - Eshetu Tefera
- From the Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, MedStar Health Research Institute, Hyattsville, Maryland, George Eliot Hospital NHS Trust, Nuneaton, United Kingdom, and the Internal Medicine Department, University of Texas Health Science Center at Houston, Houston
| | - Ragai Fouda
- From the Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, MedStar Health Research Institute, Hyattsville, Maryland, George Eliot Hospital NHS Trust, Nuneaton, United Kingdom, and the Internal Medicine Department, University of Texas Health Science Center at Houston, Houston
| | - Rukma Govindu
- From the Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, MedStar Health Research Institute, Hyattsville, Maryland, George Eliot Hospital NHS Trust, Nuneaton, United Kingdom, and the Internal Medicine Department, University of Texas Health Science Center at Houston, Houston
| |
Collapse
|
8
|
Ahn K, Govindu R. At the Knees: Inguinoscrotal Hernia. Am J Med 2019; 132:476-477. [PMID: 30550754 DOI: 10.1016/j.amjmed.2018.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Kristopher Ahn
- Department of Internal Medicine-Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston; Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston.
| | - Rukma Govindu
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston
| |
Collapse
|
9
|
Govindu R. Dystrophic Calcifications in Chronic Venous Insufficiency. Am J Med Sci 2018; 357:e7. [PMID: 30551796 DOI: 10.1016/j.amjms.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Rukma Govindu
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX.
| |
Collapse
|
10
|
Ammar H, Govindu R, Fouda R, Zohdy W, Supsupin E. Dizziness in a community hospital: central neurological causes, clinical predictors, and diagnostic yield and cost of neuroimaging studies. J Community Hosp Intern Med Perspect 2017. [PMID: 28638568 PMCID: PMC5473196 DOI: 10.1080/20009666.2017.1332317] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objectives: Neuroimaging is contributing to the rising costs of dizziness evaluation. This study examined the rate of central neurological causes of dizziness, relevant clinical predictors, and the costs and diagnostic yields of neuroimaging in dizziness assessment. Methods: We retrospectively reviewed the records of 521 adult patients who visited the hospital during a 12-month period with dizziness as the chief complaint. Clinical findings were analyzed using Fisher's exact test to determine how they correlated with central neurological causes of dizziness identified by neuroimaging. Costs and diagnostic yields of neuroimaging were calculated. Results: Of the 521 patients, 1.5% had dizziness produced by central neurological causes. Gait abnormalities, limb ataxia, diabetes mellitus, and the existence of multiple neurological findings predicted central causes. Cases were associated with gait abnormalities, limb ataxia, diabetes mellitus, and the existence of multiple neurological findings . Brain computed tomography (CT) and magnetic resonance imaging (MRI) were performed in 42% and 9.5% of the examined cases, respectively, with diagnostic yields of 3.6% and 12%, respectively. Nine cases of dizziness were diagnosed from 269 brain scans, costing $607 914. Conclusion: Clinical evaluation can predict the presence of central neurological causes of dizziness, whereas neuroimaging is a costly and low-yield approach. Guidelines are needed for physicians, regarding the appropriateness of ordering neuroimaging studies. Abbreviations: OR: odds ratio; CI: confidence interval; ED: emergency department; CT: computed tomography; MRI: magnetic resonance imaging; HINTS: Head impulse, Nystagmus, Test of skew.
Collapse
Affiliation(s)
- Hussam Ammar
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Rukma Govindu
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ragai Fouda
- Department of Internal medicine, Kasr Al Aini Hospital, Cairo University, Cairo, Egypt
| | - Wael Zohdy
- Information Technology Department, Orillia Soldiers' Memorial Hospital, Orillia, Ontario, Canada.,Andrology Department, Cairo University School of Medicine, Cairo, Egypt
| | - Emilio Supsupin
- Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| |
Collapse
|
11
|
Enkhtaivan B, Govindu R. Rare Primary Cardiac Angiosarcoma Preseting as Recurrent Cardiac Tamponade. Chest 2016. [DOI: 10.1016/j.chest.2016.08.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
12
|
Johnson PC, Ammar H, Zohdy W, Fouda R, Govindu R. Yield of Diagnostic Tests and Its Impact on Cost in Adult Patients with Syncope Presenting to a Community Hospital. South Med J 2014; 107:707-14. [DOI: 10.14423/smj.0000000000000184] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|