Patrice Wendling

CHICAGO — Protein C levels may be useful as an early biomarker to distinguish patients with sepsis from those with pneumonia.

In a retrospective chart review of 1,047 protein C tests performed in 980 patients, average protein C activity levels were significantly less in sepsis patients at 59.2% than in pneumonia patients at 108.9%, principal investigator Scott Gutovitz and his colleagues at Orlando (Fla.) Health reported in a poster presentation at the annual meeting of the American College of Emergency Physicians.

The researchers conducted the retrospective review over a 14-month period at an eight-hospital health care system. They identified 32 samples from patients with sepsis and 34 samples from patients with pneumonia and no clinical evidence of sepsis. Charts were excluded if the measurement was obtained before the sepsis/pneumonia event or more than 10 days after the event.

Protein C levels were significantly lower in the sepsis group (mean age 38 years) than in the pneumonia group (mean age 51.5 years) in the 0- to 12-hour interval after diagnosis (49% vs. 91%), 12- to 24-hour interval (61% vs. 109.3%), 24- to 48-hour interval (64% vs. 117.2%), and 48- to 240-hour interval (61.5% vs. 115%).

Although the number of patients in each subgroup was small and thus resulted in fairly large confidence intervals, the finding is fairly consistent over time, Dr. Gutovitz said in an interview.

Complicating a correct pneumonia diagnosis is the fact that pneumonia is a clinical and radiologic diagnosis, whereas sepsis is defined as the presence or presumed presence of an infection plus at least two systemic inflammatory response syndrome (SIRS) criteria.

Protein C is known to be lower in patients with sepsis, but its levels in nonseptic patients with pneumonia have not previously been quantified, he said. In a previous study, SIRS criteria were not useful predictors for progression to severe sepsis in community-acquired pneumonia (Chest 2006;129:968-78).

CHICAGO — Protein C levels may be useful as an early biomarker to distinguish patients with sepsis from those with pneumonia.

In a retrospective chart review of 1,047 protein C tests performed in 980 patients, average protein C activity levels were significantly less in sepsis patients at 59.2% than in pneumonia patients at 108.9%, principal investigator Scott Gutovitz and his colleagues at Orlando (Fla.) Health reported in a poster presentation at the annual meeting of the American College of Emergency Physicians.

The researchers conducted the retrospective review over a 14-month period at an eight-hospital health care system. They identified 32 samples from patients with sepsis and 34 samples from patients with pneumonia and no clinical evidence of sepsis. Charts were excluded if the measurement was obtained before the sepsis/pneumonia event or more than 10 days after the event.

Protein C levels were significantly lower in the sepsis group (mean age 38 years) than in the pneumonia group (mean age 51.5 years) in the 0- to 12-hour interval after diagnosis (49% vs. 91%), 12- to 24-hour interval (61% vs. 109.3%), 24- to 48-hour interval (64% vs. 117.2%), and 48- to 240-hour interval (61.5% vs. 115%).

Although the number of patients in each subgroup was small and thus resulted in fairly large confidence intervals, the finding is fairly consistent over time, Dr. Gutovitz said in an interview.

Complicating a correct pneumonia diagnosis is the fact that pneumonia is a clinical and radiologic diagnosis, whereas sepsis is defined as the presence or presumed presence of an infection plus at least two systemic inflammatory response syndrome (SIRS) criteria.

Protein C is known to be lower in patients with sepsis, but its levels in nonseptic patients with pneumonia have not previously been quantified, he said. In a previous study, SIRS criteria were not useful predictors for progression to severe sepsis in community-acquired pneumonia (Chest 2006;129:968-78).

CHICAGO — Protein C levels may be useful as an early biomarker to distinguish patients with sepsis from those with pneumonia.

In a retrospective chart review of 1,047 protein C tests performed in 980 patients, average protein C activity levels were significantly less in sepsis patients at 59.2% than in pneumonia patients at 108.9%, principal investigator Scott Gutovitz and his colleagues at Orlando (Fla.) Health reported in a poster presentation at the annual meeting of the American College of Emergency Physicians.

The researchers conducted the retrospective review over a 14-month period at an eight-hospital health care system. They identified 32 samples from patients with sepsis and 34 samples from patients with pneumonia and no clinical evidence of sepsis. Charts were excluded if the measurement was obtained before the sepsis/pneumonia event or more than 10 days after the event.

Protein C levels were significantly lower in the sepsis group (mean age 38 years) than in the pneumonia group (mean age 51.5 years) in the 0- to 12-hour interval after diagnosis (49% vs. 91%), 12- to 24-hour interval (61% vs. 109.3%), 24- to 48-hour interval (64% vs. 117.2%), and 48- to 240-hour interval (61.5% vs. 115%).

Although the number of patients in each subgroup was small and thus resulted in fairly large confidence intervals, the finding is fairly consistent over time, Dr. Gutovitz said in an interview.

Complicating a correct pneumonia diagnosis is the fact that pneumonia is a clinical and radiologic diagnosis, whereas sepsis is defined as the presence or presumed presence of an infection plus at least two systemic inflammatory response syndrome (SIRS) criteria.

Protein C is known to be lower in patients with sepsis, but its levels in nonseptic patients with pneumonia have not previously been quantified, he said. In a previous study, SIRS criteria were not useful predictors for progression to severe sepsis in community-acquired pneumonia (Chest 2006;129:968-78).

Having a family history of breast cancer was associated with a significant 2.2-fold increased risk of triple-negative breast cancer in Hispanic women, but not in black women, according to preliminary data from a study of 466 patients.

Moreover, Hispanic women were six times more likely to develop this aggressive form of cancer before age 50 years (odds ratio 6.1) when compared with black women (OR 1.5), Betsy C. Wertheim reported at the American Association for Cancer Research conference on the science of health disparities. The mean age at breast cancer diagnosis was 49 years for Hispanics and 52 years for blacks.

Subset analyses suggest that the increased risk for triple-negative breast cancer is confined to Hispanics who were born in Mexico and not in the United States.

Because the breast cancer tumors of affected women are negative for three important targets of available treatment regimens—estrogen receptors (ER), progesterone receptors (PR), and/or human epidermal growth factor receptor 2 (HER2)—their response to some treatments may be poor.

The association between family history of breast cancer and triple-negative breast cancer was increased nearly fivefold (OR 4.9) among Hispanic women living in Arizona, of whom 17% were American born. In contrast, there was no significant association among Hispanics living in Texas (OR 1.4), of whom 58% were American born.

“We aren't sure whether this association is due to environmental exposure or if it has to do with the ancestry of these women from Arizona versus Texas,” Ms. Wertheim, an assistant scientific investigator at the Arizona Cancer Center, University of Arizona, Tucson, told reporters at a press briefing.

The findings were based on 260 Hispanic women participating in the ongoing ELLA Binational Breast Cancer study and 206 black women studied with the same protocol at University of Texas M.D. Anderson Cancer Center, Houston. They ranged in age from 22 to 80 years. Family history was defined as self-reported history of breast or ovarian cancer in a relative before age 50 years.

Tumor marker data taken from medical records were used to determine if tumors were negative for ER, PR, and HER2/neu.

One genetic factor that may help explain the strong association between family history and triple-negative breast cancers is a higher burden of BRCA1 mutation carriers in the Mexican American cases, principal investigator Maria Elena Martinez, Ph.D., said in an interview.

This observation is supported by a recent study, led by Dr. Jeffrey N. Weitzel, that identified and characterized a novel large BRCA1 deletion in five unrelated high-risk families—four of Mexican ancestry (Cancer Epidemiol. Biomarkers Prev. 2007;16:1615–20). The families had a personal or family history of breast or ovarian cancer, but not necessarily triple-negative breast cancer.

Still, the findings suggest that the presence of these BRCA mutations may account for a higher proportion of breast cancer cases in young Mexican American women, similar to that of women of Ashkenazi ancestry, when compared with women who are black or non-Hispanic white.

“We're putting the pieces together,” Dr. Martinez said. “We believe there is possibly a BRCA1 mutation in these women based on his findings and extending those to our findings. Young onset, triple negative, and family history: It's crying out, as Dr. Weitzel would say, that there is a BRCA mutation in these women.”

The next logical step is to assess the rate of BRCA1 mutations in the current cohort and to confirm the findings of Dr. Weitzel, chief of the division of clinical cancer genetics at the City of Hope in Duarte, Calif.

Prior to the current study, very little was known about the rate of triple-negative breast cancer in Hispanic women, said Dr. Martinez, an epidemiology professor also with the university's Arizona Cancer Center.

If future research confirms a higher rate of BRCA1 mutations among Mexican American women, genetic counseling and advice regarding prophylactic mastectomy or oophorectomy is advisable. This must be done, however, in a culturally and language-sensitive environment, Dr. Martinez stressed.

The investigators reported no conflicts of interest. The ELLA study is supported by funding from the Avon Foundation and the National Cancer Institute.

Having a family history of breast cancer was associated with a significant 2.2-fold increased risk of triple-negative breast cancer in Hispanic women, but not in black women, according to preliminary data from a study of 466 patients.

Moreover, Hispanic women were six times more likely to develop this aggressive form of cancer before age 50 years (odds ratio 6.1) when compared with black women (OR 1.5), Betsy C. Wertheim reported at the American Association for Cancer Research conference on the science of health disparities. The mean age at breast cancer diagnosis was 49 years for Hispanics and 52 years for blacks.

Subset analyses suggest that the increased risk for triple-negative breast cancer is confined to Hispanics who were born in Mexico and not in the United States.

Because the breast cancer tumors of affected women are negative for three important targets of available treatment regimens—estrogen receptors (ER), progesterone receptors (PR), and/or human epidermal growth factor receptor 2 (HER2)—their response to some treatments may be poor.

The association between family history of breast cancer and triple-negative breast cancer was increased nearly fivefold (OR 4.9) among Hispanic women living in Arizona, of whom 17% were American born. In contrast, there was no significant association among Hispanics living in Texas (OR 1.4), of whom 58% were American born.

“We aren't sure whether this association is due to environmental exposure or if it has to do with the ancestry of these women from Arizona versus Texas,” Ms. Wertheim, an assistant scientific investigator at the Arizona Cancer Center, University of Arizona, Tucson, told reporters at a press briefing.

The findings were based on 260 Hispanic women participating in the ongoing ELLA Binational Breast Cancer study and 206 black women studied with the same protocol at University of Texas M.D. Anderson Cancer Center, Houston. They ranged in age from 22 to 80 years. Family history was defined as self-reported history of breast or ovarian cancer in a relative before age 50 years.

Tumor marker data taken from medical records were used to determine if tumors were negative for ER, PR, and HER2/neu.

One genetic factor that may help explain the strong association between family history and triple-negative breast cancers is a higher burden of BRCA1 mutation carriers in the Mexican American cases, principal investigator Maria Elena Martinez, Ph.D., said in an interview.

This observation is supported by a recent study, led by Dr. Jeffrey N. Weitzel, that identified and characterized a novel large BRCA1 deletion in five unrelated high-risk families—four of Mexican ancestry (Cancer Epidemiol. Biomarkers Prev. 2007;16:1615–20). The families had a personal or family history of breast or ovarian cancer, but not necessarily triple-negative breast cancer.

Still, the findings suggest that the presence of these BRCA mutations may account for a higher proportion of breast cancer cases in young Mexican American women, similar to that of women of Ashkenazi ancestry, when compared with women who are black or non-Hispanic white.

“We're putting the pieces together,” Dr. Martinez said. “We believe there is possibly a BRCA1 mutation in these women based on his findings and extending those to our findings. Young onset, triple negative, and family history: It's crying out, as Dr. Weitzel would say, that there is a BRCA mutation in these women.”

The next logical step is to assess the rate of BRCA1 mutations in the current cohort and to confirm the findings of Dr. Weitzel, chief of the division of clinical cancer genetics at the City of Hope in Duarte, Calif.

Prior to the current study, very little was known about the rate of triple-negative breast cancer in Hispanic women, said Dr. Martinez, an epidemiology professor also with the university's Arizona Cancer Center.

If future research confirms a higher rate of BRCA1 mutations among Mexican American women, genetic counseling and advice regarding prophylactic mastectomy or oophorectomy is advisable. This must be done, however, in a culturally and language-sensitive environment, Dr. Martinez stressed.

The investigators reported no conflicts of interest. The ELLA study is supported by funding from the Avon Foundation and the National Cancer Institute.

Having a family history of breast cancer was associated with a significant 2.2-fold increased risk of triple-negative breast cancer in Hispanic women, but not in black women, according to preliminary data from a study of 466 patients.

Moreover, Hispanic women were six times more likely to develop this aggressive form of cancer before age 50 years (odds ratio 6.1) when compared with black women (OR 1.5), Betsy C. Wertheim reported at the American Association for Cancer Research conference on the science of health disparities. The mean age at breast cancer diagnosis was 49 years for Hispanics and 52 years for blacks.

Subset analyses suggest that the increased risk for triple-negative breast cancer is confined to Hispanics who were born in Mexico and not in the United States.

Because the breast cancer tumors of affected women are negative for three important targets of available treatment regimens—estrogen receptors (ER), progesterone receptors (PR), and/or human epidermal growth factor receptor 2 (HER2)—their response to some treatments may be poor.

The association between family history of breast cancer and triple-negative breast cancer was increased nearly fivefold (OR 4.9) among Hispanic women living in Arizona, of whom 17% were American born. In contrast, there was no significant association among Hispanics living in Texas (OR 1.4), of whom 58% were American born.

“We aren't sure whether this association is due to environmental exposure or if it has to do with the ancestry of these women from Arizona versus Texas,” Ms. Wertheim, an assistant scientific investigator at the Arizona Cancer Center, University of Arizona, Tucson, told reporters at a press briefing.

The findings were based on 260 Hispanic women participating in the ongoing ELLA Binational Breast Cancer study and 206 black women studied with the same protocol at University of Texas M.D. Anderson Cancer Center, Houston. They ranged in age from 22 to 80 years. Family history was defined as self-reported history of breast or ovarian cancer in a relative before age 50 years.

Tumor marker data taken from medical records were used to determine if tumors were negative for ER, PR, and HER2/neu.

One genetic factor that may help explain the strong association between family history and triple-negative breast cancers is a higher burden of BRCA1 mutation carriers in the Mexican American cases, principal investigator Maria Elena Martinez, Ph.D., said in an interview.

This observation is supported by a recent study, led by Dr. Jeffrey N. Weitzel, that identified and characterized a novel large BRCA1 deletion in five unrelated high-risk families—four of Mexican ancestry (Cancer Epidemiol. Biomarkers Prev. 2007;16:1615–20). The families had a personal or family history of breast or ovarian cancer, but not necessarily triple-negative breast cancer.

Still, the findings suggest that the presence of these BRCA mutations may account for a higher proportion of breast cancer cases in young Mexican American women, similar to that of women of Ashkenazi ancestry, when compared with women who are black or non-Hispanic white.

“We're putting the pieces together,” Dr. Martinez said. “We believe there is possibly a BRCA1 mutation in these women based on his findings and extending those to our findings. Young onset, triple negative, and family history: It's crying out, as Dr. Weitzel would say, that there is a BRCA mutation in these women.”

The next logical step is to assess the rate of BRCA1 mutations in the current cohort and to confirm the findings of Dr. Weitzel, chief of the division of clinical cancer genetics at the City of Hope in Duarte, Calif.

Prior to the current study, very little was known about the rate of triple-negative breast cancer in Hispanic women, said Dr. Martinez, an epidemiology professor also with the university's Arizona Cancer Center.

If future research confirms a higher rate of BRCA1 mutations among Mexican American women, genetic counseling and advice regarding prophylactic mastectomy or oophorectomy is advisable. This must be done, however, in a culturally and language-sensitive environment, Dr. Martinez stressed.

The investigators reported no conflicts of interest. The ELLA study is supported by funding from the Avon Foundation and the National Cancer Institute.

An alarming 51% of women failed to seek out medical care after detecting a change in their breasts through self-examination, in a study of 314 Mexican American women with invasive breast cancer.

The most common method of breast cancer detection was self-exam (68%), which included routine breast exam and incidental self-discovery, followed by screening mammography (22%), clinical exam by a health professional (6%), and other methods (5%) (percentages are rounded).

The study was reported by Rachel Zenuk and her associates in a poster at a conference sponsored by the American Association for Cancer Research.

After noticing a change in their breasts, 159 of the women reported waiting a month or more before seeking medical attention.

Of these, 143 waited 1–11 months and 16 patients waited 1 year or more.

The most common reasons for prolonging medical care were the following: They “did not feel it was important” (33%), they did not have insurance (31%), they were afraid (13%), and their physicians did not have any earlier appointments (12%).

The low rate of mammography screening in the Hispanic women in this study stands in sharp contrast to rates of 70%–80% reported among Hispanics in national surveys such as the Breast Risk Factor Survey, Ms. Zenuk, a graduate student at the University of Arizona Cancer Center in Tucson, told reporters at a press briefing.

However, previous studies have demonstrated that large ethno-regional differences in breast cancer screening rates exist among Hispanic groups across the country, with less than 50% of Mexican American women in Texas border regions reporting having received recent mammograms (Health Educ. Res. 2000;15:559–68).

Ms. Zenuk and her associates evaluated a variety of sociocultural factors that might have influenced mammography utilization in their cohort.

Women aged 25–86 years (median 49 years) were recruited from Houston and various Arizona cities and completed the ELLA Risk Factor Questionnaire via interviews in English and Spanish.

At the time of the interview, 264 of the 314 women were aged 40 or older. Among these women, 72% reported undergoing prior mammography.

Significant differences in mammography screening were observed between women who reported high English language use (85%) and those with lower use (59%), the investigators reported.

Those with a high school degree or higher were also significantly more likely to have received prior mammography versus those with lower levels of education (77% vs. 64%).

The same was true of Mexican American women born in the United States (85%), compared with those born outside the United States (63%).

A majority of the Mexican American women in this study (73%) reported high exposure to Spanish media, suggesting a way to improve culturally appropriate beast cancer screening education, including information about affordable medical programs in their communities, the authors wrote.

“We're definitely thinking that we have to develop an intervention model that addresses these complex issues, including prompt detection and reporting” when breast changes are detected, Ms. Zenuk told reporters.

The study is part of the ELLA Binational Breast Cancer Study, which is funded by the National Cancer Institute and the Avon Foundation.

The investigators reported no conflicts of interest.

An alarming 51% of women failed to seek out medical care after detecting a change in their breasts through self-examination, in a study of 314 Mexican American women with invasive breast cancer.

The most common method of breast cancer detection was self-exam (68%), which included routine breast exam and incidental self-discovery, followed by screening mammography (22%), clinical exam by a health professional (6%), and other methods (5%) (percentages are rounded).

The study was reported by Rachel Zenuk and her associates in a poster at a conference sponsored by the American Association for Cancer Research.

After noticing a change in their breasts, 159 of the women reported waiting a month or more before seeking medical attention.

Of these, 143 waited 1–11 months and 16 patients waited 1 year or more.

The most common reasons for prolonging medical care were the following: They “did not feel it was important” (33%), they did not have insurance (31%), they were afraid (13%), and their physicians did not have any earlier appointments (12%).

The low rate of mammography screening in the Hispanic women in this study stands in sharp contrast to rates of 70%–80% reported among Hispanics in national surveys such as the Breast Risk Factor Survey, Ms. Zenuk, a graduate student at the University of Arizona Cancer Center in Tucson, told reporters at a press briefing.

However, previous studies have demonstrated that large ethno-regional differences in breast cancer screening rates exist among Hispanic groups across the country, with less than 50% of Mexican American women in Texas border regions reporting having received recent mammograms (Health Educ. Res. 2000;15:559–68).

Ms. Zenuk and her associates evaluated a variety of sociocultural factors that might have influenced mammography utilization in their cohort.

Women aged 25–86 years (median 49 years) were recruited from Houston and various Arizona cities and completed the ELLA Risk Factor Questionnaire via interviews in English and Spanish.

At the time of the interview, 264 of the 314 women were aged 40 or older. Among these women, 72% reported undergoing prior mammography.

Significant differences in mammography screening were observed between women who reported high English language use (85%) and those with lower use (59%), the investigators reported.

Those with a high school degree or higher were also significantly more likely to have received prior mammography versus those with lower levels of education (77% vs. 64%).

The same was true of Mexican American women born in the United States (85%), compared with those born outside the United States (63%).

A majority of the Mexican American women in this study (73%) reported high exposure to Spanish media, suggesting a way to improve culturally appropriate beast cancer screening education, including information about affordable medical programs in their communities, the authors wrote.

“We're definitely thinking that we have to develop an intervention model that addresses these complex issues, including prompt detection and reporting” when breast changes are detected, Ms. Zenuk told reporters.

The study is part of the ELLA Binational Breast Cancer Study, which is funded by the National Cancer Institute and the Avon Foundation.

The investigators reported no conflicts of interest.

An alarming 51% of women failed to seek out medical care after detecting a change in their breasts through self-examination, in a study of 314 Mexican American women with invasive breast cancer.

The most common method of breast cancer detection was self-exam (68%), which included routine breast exam and incidental self-discovery, followed by screening mammography (22%), clinical exam by a health professional (6%), and other methods (5%) (percentages are rounded).

The study was reported by Rachel Zenuk and her associates in a poster at a conference sponsored by the American Association for Cancer Research.

After noticing a change in their breasts, 159 of the women reported waiting a month or more before seeking medical attention.

Of these, 143 waited 1–11 months and 16 patients waited 1 year or more.

The most common reasons for prolonging medical care were the following: They “did not feel it was important” (33%), they did not have insurance (31%), they were afraid (13%), and their physicians did not have any earlier appointments (12%).

The low rate of mammography screening in the Hispanic women in this study stands in sharp contrast to rates of 70%–80% reported among Hispanics in national surveys such as the Breast Risk Factor Survey, Ms. Zenuk, a graduate student at the University of Arizona Cancer Center in Tucson, told reporters at a press briefing.

However, previous studies have demonstrated that large ethno-regional differences in breast cancer screening rates exist among Hispanic groups across the country, with less than 50% of Mexican American women in Texas border regions reporting having received recent mammograms (Health Educ. Res. 2000;15:559–68).

Ms. Zenuk and her associates evaluated a variety of sociocultural factors that might have influenced mammography utilization in their cohort.

Women aged 25–86 years (median 49 years) were recruited from Houston and various Arizona cities and completed the ELLA Risk Factor Questionnaire via interviews in English and Spanish.

At the time of the interview, 264 of the 314 women were aged 40 or older. Among these women, 72% reported undergoing prior mammography.

Significant differences in mammography screening were observed between women who reported high English language use (85%) and those with lower use (59%), the investigators reported.

Those with a high school degree or higher were also significantly more likely to have received prior mammography versus those with lower levels of education (77% vs. 64%).

The same was true of Mexican American women born in the United States (85%), compared with those born outside the United States (63%).

A majority of the Mexican American women in this study (73%) reported high exposure to Spanish media, suggesting a way to improve culturally appropriate beast cancer screening education, including information about affordable medical programs in their communities, the authors wrote.

“We're definitely thinking that we have to develop an intervention model that addresses these complex issues, including prompt detection and reporting” when breast changes are detected, Ms. Zenuk told reporters.

The study is part of the ELLA Binational Breast Cancer Study, which is funded by the National Cancer Institute and the Avon Foundation.

The investigators reported no conflicts of interest.

CHICAGO — One of every nine men over age 59 years with a diagnosis of stroke or transient ischemic attack had an abdominal aortic aneurysm in a prospective study of 499 patients.

Among all patients admitted for stroke or TIA, the prevalence of abdominal aortic aneurysm (AAA) on ultrasound evaluation was 5.8%. This is comparable to the prevalence in other populations and was not significant.

AAA prevalence was 11.1% in a subgroup of 235 men aged 59 years and older (median 72 years), Dr. Niels H.A. Van Lindert and colleagues reported at the annual meeting of the Radiological Society of North America. The prevalence in the subgroup was significantly higher than the 4.0%–8.1% prevalence found in three recent population-based screening studies in men over 59 years of age.

The finding could lead to improved screening and earlier treatment of this high-risk group, said Dr. Van Lindert, of the Gelre Hospitals Apeldoorn (the Netherlands). Although the use of ultrasound is noninvasive, low-cost, accurate, and fast, most abdominal aneurysms are found by chance in men of older age and with a history of smoking.

“In our group, 55% of aneurysms were in nonsmokers, which meant that detection would not have occurred following task force rules,” he said. The United States Preventive Services Task Force (USPSTF) recommends a one-time ultrasonography screening of all men aged 65–75 years with a history of smoking.

The USPSTF makes no recommendation for or against screening for AAA in men aged 65–75 years who have never smoked, and recommends against routine screening for AAA in women.

Dr. Van Lindert advised that all men older than 59 years of age admitted with a stroke or TIA be screened for an AAA.

Further studies are needed to determine the cost-benefit aspects of screening in this patient population with a shorter life expectancy, he said.

The investigators reported having no conflicts of interest.

CHICAGO — One of every nine men over age 59 years with a diagnosis of stroke or transient ischemic attack had an abdominal aortic aneurysm in a prospective study of 499 patients.

Among all patients admitted for stroke or TIA, the prevalence of abdominal aortic aneurysm (AAA) on ultrasound evaluation was 5.8%. This is comparable to the prevalence in other populations and was not significant.

AAA prevalence was 11.1% in a subgroup of 235 men aged 59 years and older (median 72 years), Dr. Niels H.A. Van Lindert and colleagues reported at the annual meeting of the Radiological Society of North America. The prevalence in the subgroup was significantly higher than the 4.0%–8.1% prevalence found in three recent population-based screening studies in men over 59 years of age.

The finding could lead to improved screening and earlier treatment of this high-risk group, said Dr. Van Lindert, of the Gelre Hospitals Apeldoorn (the Netherlands). Although the use of ultrasound is noninvasive, low-cost, accurate, and fast, most abdominal aneurysms are found by chance in men of older age and with a history of smoking.

“In our group, 55% of aneurysms were in nonsmokers, which meant that detection would not have occurred following task force rules,” he said. The United States Preventive Services Task Force (USPSTF) recommends a one-time ultrasonography screening of all men aged 65–75 years with a history of smoking.

The USPSTF makes no recommendation for or against screening for AAA in men aged 65–75 years who have never smoked, and recommends against routine screening for AAA in women.

Dr. Van Lindert advised that all men older than 59 years of age admitted with a stroke or TIA be screened for an AAA.

Further studies are needed to determine the cost-benefit aspects of screening in this patient population with a shorter life expectancy, he said.

The investigators reported having no conflicts of interest.

CHICAGO — One of every nine men over age 59 years with a diagnosis of stroke or transient ischemic attack had an abdominal aortic aneurysm in a prospective study of 499 patients.

Among all patients admitted for stroke or TIA, the prevalence of abdominal aortic aneurysm (AAA) on ultrasound evaluation was 5.8%. This is comparable to the prevalence in other populations and was not significant.

AAA prevalence was 11.1% in a subgroup of 235 men aged 59 years and older (median 72 years), Dr. Niels H.A. Van Lindert and colleagues reported at the annual meeting of the Radiological Society of North America. The prevalence in the subgroup was significantly higher than the 4.0%–8.1% prevalence found in three recent population-based screening studies in men over 59 years of age.

The finding could lead to improved screening and earlier treatment of this high-risk group, said Dr. Van Lindert, of the Gelre Hospitals Apeldoorn (the Netherlands). Although the use of ultrasound is noninvasive, low-cost, accurate, and fast, most abdominal aneurysms are found by chance in men of older age and with a history of smoking.

“In our group, 55% of aneurysms were in nonsmokers, which meant that detection would not have occurred following task force rules,” he said. The United States Preventive Services Task Force (USPSTF) recommends a one-time ultrasonography screening of all men aged 65–75 years with a history of smoking.

The USPSTF makes no recommendation for or against screening for AAA in men aged 65–75 years who have never smoked, and recommends against routine screening for AAA in women.

Dr. Van Lindert advised that all men older than 59 years of age admitted with a stroke or TIA be screened for an AAA.

Further studies are needed to determine the cost-benefit aspects of screening in this patient population with a shorter life expectancy, he said.

The investigators reported having no conflicts of interest.

Slightly more than 2 million cancer survivors in the United States forego necessary medical care because of cost concerns, and Hispanics and African Americans are twice as likely to do so, new research suggests.

Using the annual National Health Interview Survey database for 2003–2006, investigators identified 6,602 adult cancer survivors and 104,364 individuals with no history of cancer. During the survey, individuals were specifically asked if, during the past 12 months, there was a time when they needed medical care but did not get it because they could not afford it.

The overall prevalence of forgoing care because of cost among cancer survivors was 8% for general medical care, 10% for prescription medication, 11% for dental care, and 3% for mental health care, lead author Kathryn E. Weaver, Ph.D., and associates reported at the American Association for Cancer Research conference on the science of health care disparities.

Based on this analysis, “slightly more than 2 million cancer survivors did not get the medical care that they needed because of cost,” Dr. Weaver, a cancer prevention fellow at the National Cancer Institute, said in an interview. There are 12 million cancer survivors in the United States, according to the most recent NCI Surveillance, Epidemiology, and End Results (SEER) data through 2007.

“Access to medical care is vitally important to this population, and we need to find ways of increasing their access to needed medical services,” she said. “Short of that, physicians should be aware that a significant number of cancer survivors are not getting care, and should make efforts to hook them up with free or low-cost services.”

When compared with white survivors, Hispanic survivors were more likely to forgo medical care (odds ratio, 1.55), prescription medications (OR, 2.14) and dental care (OR, 2.31). African American survivors were more likely than white survivors to forgo prescription medications (OR, 1.87) and dental care (OR, 1.57).

“The reason for this [underutilization] is largely due to insurance coverage rates, because when you adjust for coverage status and education, the disparity disappears,” she said.

In all, 12.5% of the 3,141 cancer survivors who were younger than 65 years had no insurance coverage, compared with 20% of those of a similar age without a history of cancer.

After adjusting the data for health insurance status, education, and non-cancer related comorbidities, none of the interactions between cancer history and ethnicity was significant in the 3,461 survivors aged 65 years and older—a population almost entirely covered by the national Medicare program.

After adjustment, Hispanics aged younger than 65 years without a history of cancer were significantly less likely than their white counterparts to forgo medications (OR, 0.76) and dental care (OR, 0.74), but this pattern reversed for cancer survivors, Dr. Weaver said. Younger Hispanic cancer survivors were significantly more likely to forgo prescriptions (OR, 1.19) and dental care (OR, 1.31), compared with young white survivors.

Younger Hispanic cancer survivors may perceive such services, which are typically paid out of pocket, as being less important than seeing a physician, Dr. Weaver said. Some suggest that Hispanics in the general population are less likely to forgo health care services because of the “healthy immigrant effect.” This hypothesis has been suggested as an explanation for lower rates of many chronic diseases—including breast, cervical, and ovarian cancers—in recent immigrants, although this health advantage seems to disappear as time residing in the United States increases, she said.

Dr. Weaver acknowledged that the number of ethnic minority survivors in the sample was small, but said it is possible to extrapolate the findings to American cancer survivors because the population-based National Health Interview Survey is representative of the general population at large, and it oversamples the number of blacks and Hispanics.

The study was limited by a lack of information on the survivors' treatment status, she said. What was known is that 59% of survivors were more than 5 years post diagnosis at the time of the survey, 36% were 1–5 years post diagnosis, and 5% were less than 1 year since diagnosis.

The time since diagnosis was not significantly related to the forgoing of medical care, but should be studied further because of the potential for cancer recurrence and chemotherapy side effects (such as heart failure) to emerge over time.

“We need more research to look at cancer survivors who are at different points in the survival trajectory to understand what the financial barriers to care are at each of these points, because they might differ,” Dr. Weaver said. “Something we're extremely concerned about in the [NCI's] Office of Cancer Survivorship is the occurrence of late effects of cancer and its treatment. That could be one explanation for why survivors are in need of care years after their diagnosis.”

The study was supported by the NCI. The investigators disclosed no conflicts of interest.

ELSEVIER GLOBAL MEDICAL NEWS

Slightly more than 2 million cancer survivors in the United States forego necessary medical care because of cost concerns, and Hispanics and African Americans are twice as likely to do so, new research suggests.

Using the annual National Health Interview Survey database for 2003–2006, investigators identified 6,602 adult cancer survivors and 104,364 individuals with no history of cancer. During the survey, individuals were specifically asked if, during the past 12 months, there was a time when they needed medical care but did not get it because they could not afford it.

The overall prevalence of forgoing care because of cost among cancer survivors was 8% for general medical care, 10% for prescription medication, 11% for dental care, and 3% for mental health care, lead author Kathryn E. Weaver, Ph.D., and associates reported at the American Association for Cancer Research conference on the science of health care disparities.

Based on this analysis, “slightly more than 2 million cancer survivors did not get the medical care that they needed because of cost,” Dr. Weaver, a cancer prevention fellow at the National Cancer Institute, said in an interview. There are 12 million cancer survivors in the United States, according to the most recent NCI Surveillance, Epidemiology, and End Results (SEER) data through 2007.

“Access to medical care is vitally important to this population, and we need to find ways of increasing their access to needed medical services,” she said. “Short of that, physicians should be aware that a significant number of cancer survivors are not getting care, and should make efforts to hook them up with free or low-cost services.”

When compared with white survivors, Hispanic survivors were more likely to forgo medical care (odds ratio, 1.55), prescription medications (OR, 2.14) and dental care (OR, 2.31). African American survivors were more likely than white survivors to forgo prescription medications (OR, 1.87) and dental care (OR, 1.57).

“The reason for this [underutilization] is largely due to insurance coverage rates, because when you adjust for coverage status and education, the disparity disappears,” she said.

In all, 12.5% of the 3,141 cancer survivors who were younger than 65 years had no insurance coverage, compared with 20% of those of a similar age without a history of cancer.

After adjusting the data for health insurance status, education, and non-cancer related comorbidities, none of the interactions between cancer history and ethnicity was significant in the 3,461 survivors aged 65 years and older—a population almost entirely covered by the national Medicare program.

After adjustment, Hispanics aged younger than 65 years without a history of cancer were significantly less likely than their white counterparts to forgo medications (OR, 0.76) and dental care (OR, 0.74), but this pattern reversed for cancer survivors, Dr. Weaver said. Younger Hispanic cancer survivors were significantly more likely to forgo prescriptions (OR, 1.19) and dental care (OR, 1.31), compared with young white survivors.

Younger Hispanic cancer survivors may perceive such services, which are typically paid out of pocket, as being less important than seeing a physician, Dr. Weaver said. Some suggest that Hispanics in the general population are less likely to forgo health care services because of the “healthy immigrant effect.” This hypothesis has been suggested as an explanation for lower rates of many chronic diseases—including breast, cervical, and ovarian cancers—in recent immigrants, although this health advantage seems to disappear as time residing in the United States increases, she said.

Dr. Weaver acknowledged that the number of ethnic minority survivors in the sample was small, but said it is possible to extrapolate the findings to American cancer survivors because the population-based National Health Interview Survey is representative of the general population at large, and it oversamples the number of blacks and Hispanics.

The study was limited by a lack of information on the survivors' treatment status, she said. What was known is that 59% of survivors were more than 5 years post diagnosis at the time of the survey, 36% were 1–5 years post diagnosis, and 5% were less than 1 year since diagnosis.

The time since diagnosis was not significantly related to the forgoing of medical care, but should be studied further because of the potential for cancer recurrence and chemotherapy side effects (such as heart failure) to emerge over time.

“We need more research to look at cancer survivors who are at different points in the survival trajectory to understand what the financial barriers to care are at each of these points, because they might differ,” Dr. Weaver said. “Something we're extremely concerned about in the [NCI's] Office of Cancer Survivorship is the occurrence of late effects of cancer and its treatment. That could be one explanation for why survivors are in need of care years after their diagnosis.”

The study was supported by the NCI. The investigators disclosed no conflicts of interest.

ELSEVIER GLOBAL MEDICAL NEWS

Slightly more than 2 million cancer survivors in the United States forego necessary medical care because of cost concerns, and Hispanics and African Americans are twice as likely to do so, new research suggests.

Using the annual National Health Interview Survey database for 2003–2006, investigators identified 6,602 adult cancer survivors and 104,364 individuals with no history of cancer. During the survey, individuals were specifically asked if, during the past 12 months, there was a time when they needed medical care but did not get it because they could not afford it.

The overall prevalence of forgoing care because of cost among cancer survivors was 8% for general medical care, 10% for prescription medication, 11% for dental care, and 3% for mental health care, lead author Kathryn E. Weaver, Ph.D., and associates reported at the American Association for Cancer Research conference on the science of health care disparities.

Based on this analysis, “slightly more than 2 million cancer survivors did not get the medical care that they needed because of cost,” Dr. Weaver, a cancer prevention fellow at the National Cancer Institute, said in an interview. There are 12 million cancer survivors in the United States, according to the most recent NCI Surveillance, Epidemiology, and End Results (SEER) data through 2007.

“Access to medical care is vitally important to this population, and we need to find ways of increasing their access to needed medical services,” she said. “Short of that, physicians should be aware that a significant number of cancer survivors are not getting care, and should make efforts to hook them up with free or low-cost services.”

When compared with white survivors, Hispanic survivors were more likely to forgo medical care (odds ratio, 1.55), prescription medications (OR, 2.14) and dental care (OR, 2.31). African American survivors were more likely than white survivors to forgo prescription medications (OR, 1.87) and dental care (OR, 1.57).

“The reason for this [underutilization] is largely due to insurance coverage rates, because when you adjust for coverage status and education, the disparity disappears,” she said.

In all, 12.5% of the 3,141 cancer survivors who were younger than 65 years had no insurance coverage, compared with 20% of those of a similar age without a history of cancer.

After adjusting the data for health insurance status, education, and non-cancer related comorbidities, none of the interactions between cancer history and ethnicity was significant in the 3,461 survivors aged 65 years and older—a population almost entirely covered by the national Medicare program.

After adjustment, Hispanics aged younger than 65 years without a history of cancer were significantly less likely than their white counterparts to forgo medications (OR, 0.76) and dental care (OR, 0.74), but this pattern reversed for cancer survivors, Dr. Weaver said. Younger Hispanic cancer survivors were significantly more likely to forgo prescriptions (OR, 1.19) and dental care (OR, 1.31), compared with young white survivors.

Younger Hispanic cancer survivors may perceive such services, which are typically paid out of pocket, as being less important than seeing a physician, Dr. Weaver said. Some suggest that Hispanics in the general population are less likely to forgo health care services because of the “healthy immigrant effect.” This hypothesis has been suggested as an explanation for lower rates of many chronic diseases—including breast, cervical, and ovarian cancers—in recent immigrants, although this health advantage seems to disappear as time residing in the United States increases, she said.

Dr. Weaver acknowledged that the number of ethnic minority survivors in the sample was small, but said it is possible to extrapolate the findings to American cancer survivors because the population-based National Health Interview Survey is representative of the general population at large, and it oversamples the number of blacks and Hispanics.

The study was limited by a lack of information on the survivors' treatment status, she said. What was known is that 59% of survivors were more than 5 years post diagnosis at the time of the survey, 36% were 1–5 years post diagnosis, and 5% were less than 1 year since diagnosis.

The time since diagnosis was not significantly related to the forgoing of medical care, but should be studied further because of the potential for cancer recurrence and chemotherapy side effects (such as heart failure) to emerge over time.

“We need more research to look at cancer survivors who are at different points in the survival trajectory to understand what the financial barriers to care are at each of these points, because they might differ,” Dr. Weaver said. “Something we're extremely concerned about in the [NCI's] Office of Cancer Survivorship is the occurrence of late effects of cancer and its treatment. That could be one explanation for why survivors are in need of care years after their diagnosis.”

The study was supported by the NCI. The investigators disclosed no conflicts of interest.

ELSEVIER GLOBAL MEDICAL NEWS

CHICAGO — Brief exposure to acupuncture significantly improved the symptoms of posttraumatic stress disorder when this treatment was compared with usual care, in a randomized controlled trial in 55 veterans.

Traditional Chinese medicine (TCM) acupuncture was evaluated for posttraumatic stress disorder (PTSD) because current treatments are only modestly effective, and some evidence exists for the efficacy of acupuncture in depression, anxiety, insomnia, and chronic pain syndrome, said Col. Charles C. Engel, MC, USA, who is director of the Department of Defense deployment health clinical center at Walter Reed Army Medical Center, Washington.

In addition, roughly 10%–17% of soldiers returning from the Iraq War experience PTSD in the year after deployment. The median time to care for most veterans is 12 years.

“I've done drug trials [and] psychotherapy trials, and this is the easiest trial in terms of recruitment,” Dr. Engel said at the annual meeting of the International Society for Traumatic Stress Studies. “Patients were excited about this as a modality.”

Dr. Engel and his associates randomized 55 active-duty personnel with PTSD to usual care (medication or psychosocial therapy) or eight 90-minute TCM acupuncture sessions delivered twice weekly for 4 weeks, plus usual care. The acupuncture sessions, which included needling and patient-practitioner interaction, were standardized for the first four sessions and individualized for the second four sessions. All practitioners held a master's degree in TCM acupuncture.

The mean Clinician-Administered PTSD Scale (CAPS) score at baseline was 76.2 in the acupuncture group and 70.0 in the usual care group, while the mean PTSD Checklist-Civilian Version (PCL-C) scores were 58.1 and 55.4. The civilian version was deliberately chosen because people in the military may have PTSD from multiple causes, only one of which is combat, Dr. Engel explained at the meeting cosponsored by Boston University.

Most of the patients were male (64.3% in the acupuncture group and 74% in the usual care group), the mean age of the two groups was 37 and 33 years, and 68% of all patients were recruited from primary care providers.

Patients with moderate to severe brain injury were excluded, as were those who had had a psychological trauma during the 30 days prior to randomization.

The analysis was based on 19 of 28 (68%) acupuncture patients and 24 of 27 (89%) usual care patients.

Compared with usual care, acupuncture was associated with significantly greater decreases in PTSD symptoms on CAPS and PCL-C, and these improvements were maintained through the 12-week follow-up, said Dr. Engel, who is also with the department of psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md. The mean PCL-C decreases were 19.4 at the end of treatment and 19.8 at the 12-week follow-up in the acupuncture group, compared with 4.0 and 9.7 in the usual care group. Cohen's d measures of effect sizes both before and after treatment and between groups were large (all greater than 1.0), he noted.

Symptoms of depression and pain also significantly improved in the acupuncture group, compared with the usual care group. The 36-Item Short Form Health Survey (SF-36) scores for mental functioning improved significantly with acupuncture. There was a trend toward improvement in physical functioning on the SF-36, but it likely didn't reach significance because the sample was fairly healthy physically and didn't have much room to improve, Dr. Engel said in an interview.

The investigators are interested in conducting a large multicenter trial that would involve a sham acupuncture arm in addition to the usual care and regular acupuncture arms examined in the current study.

VET-HEAL, a research program of the Samueli Institute for Information Biology, in Alexandria, Va., provided funding for the study. Dr. Engel reported no relevant conflicts of interest.

'This is the easiest trial in terms of recruitment. Patients were excited about this as a modality.' DR. ENGEL

CHICAGO — Brief exposure to acupuncture significantly improved the symptoms of posttraumatic stress disorder when this treatment was compared with usual care, in a randomized controlled trial in 55 veterans.

Traditional Chinese medicine (TCM) acupuncture was evaluated for posttraumatic stress disorder (PTSD) because current treatments are only modestly effective, and some evidence exists for the efficacy of acupuncture in depression, anxiety, insomnia, and chronic pain syndrome, said Col. Charles C. Engel, MC, USA, who is director of the Department of Defense deployment health clinical center at Walter Reed Army Medical Center, Washington.

In addition, roughly 10%–17% of soldiers returning from the Iraq War experience PTSD in the year after deployment. The median time to care for most veterans is 12 years.

“I've done drug trials [and] psychotherapy trials, and this is the easiest trial in terms of recruitment,” Dr. Engel said at the annual meeting of the International Society for Traumatic Stress Studies. “Patients were excited about this as a modality.”

Dr. Engel and his associates randomized 55 active-duty personnel with PTSD to usual care (medication or psychosocial therapy) or eight 90-minute TCM acupuncture sessions delivered twice weekly for 4 weeks, plus usual care. The acupuncture sessions, which included needling and patient-practitioner interaction, were standardized for the first four sessions and individualized for the second four sessions. All practitioners held a master's degree in TCM acupuncture.

The mean Clinician-Administered PTSD Scale (CAPS) score at baseline was 76.2 in the acupuncture group and 70.0 in the usual care group, while the mean PTSD Checklist-Civilian Version (PCL-C) scores were 58.1 and 55.4. The civilian version was deliberately chosen because people in the military may have PTSD from multiple causes, only one of which is combat, Dr. Engel explained at the meeting cosponsored by Boston University.

Most of the patients were male (64.3% in the acupuncture group and 74% in the usual care group), the mean age of the two groups was 37 and 33 years, and 68% of all patients were recruited from primary care providers.

Patients with moderate to severe brain injury were excluded, as were those who had had a psychological trauma during the 30 days prior to randomization.

The analysis was based on 19 of 28 (68%) acupuncture patients and 24 of 27 (89%) usual care patients.

Compared with usual care, acupuncture was associated with significantly greater decreases in PTSD symptoms on CAPS and PCL-C, and these improvements were maintained through the 12-week follow-up, said Dr. Engel, who is also with the department of psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md. The mean PCL-C decreases were 19.4 at the end of treatment and 19.8 at the 12-week follow-up in the acupuncture group, compared with 4.0 and 9.7 in the usual care group. Cohen's d measures of effect sizes both before and after treatment and between groups were large (all greater than 1.0), he noted.

Symptoms of depression and pain also significantly improved in the acupuncture group, compared with the usual care group. The 36-Item Short Form Health Survey (SF-36) scores for mental functioning improved significantly with acupuncture. There was a trend toward improvement in physical functioning on the SF-36, but it likely didn't reach significance because the sample was fairly healthy physically and didn't have much room to improve, Dr. Engel said in an interview.

The investigators are interested in conducting a large multicenter trial that would involve a sham acupuncture arm in addition to the usual care and regular acupuncture arms examined in the current study.

VET-HEAL, a research program of the Samueli Institute for Information Biology, in Alexandria, Va., provided funding for the study. Dr. Engel reported no relevant conflicts of interest.

'This is the easiest trial in terms of recruitment. Patients were excited about this as a modality.' DR. ENGEL

CHICAGO — Brief exposure to acupuncture significantly improved the symptoms of posttraumatic stress disorder when this treatment was compared with usual care, in a randomized controlled trial in 55 veterans.

Traditional Chinese medicine (TCM) acupuncture was evaluated for posttraumatic stress disorder (PTSD) because current treatments are only modestly effective, and some evidence exists for the efficacy of acupuncture in depression, anxiety, insomnia, and chronic pain syndrome, said Col. Charles C. Engel, MC, USA, who is director of the Department of Defense deployment health clinical center at Walter Reed Army Medical Center, Washington.

In addition, roughly 10%–17% of soldiers returning from the Iraq War experience PTSD in the year after deployment. The median time to care for most veterans is 12 years.

“I've done drug trials [and] psychotherapy trials, and this is the easiest trial in terms of recruitment,” Dr. Engel said at the annual meeting of the International Society for Traumatic Stress Studies. “Patients were excited about this as a modality.”

Dr. Engel and his associates randomized 55 active-duty personnel with PTSD to usual care (medication or psychosocial therapy) or eight 90-minute TCM acupuncture sessions delivered twice weekly for 4 weeks, plus usual care. The acupuncture sessions, which included needling and patient-practitioner interaction, were standardized for the first four sessions and individualized for the second four sessions. All practitioners held a master's degree in TCM acupuncture.

The mean Clinician-Administered PTSD Scale (CAPS) score at baseline was 76.2 in the acupuncture group and 70.0 in the usual care group, while the mean PTSD Checklist-Civilian Version (PCL-C) scores were 58.1 and 55.4. The civilian version was deliberately chosen because people in the military may have PTSD from multiple causes, only one of which is combat, Dr. Engel explained at the meeting cosponsored by Boston University.

Most of the patients were male (64.3% in the acupuncture group and 74% in the usual care group), the mean age of the two groups was 37 and 33 years, and 68% of all patients were recruited from primary care providers.

Patients with moderate to severe brain injury were excluded, as were those who had had a psychological trauma during the 30 days prior to randomization.

The analysis was based on 19 of 28 (68%) acupuncture patients and 24 of 27 (89%) usual care patients.

Compared with usual care, acupuncture was associated with significantly greater decreases in PTSD symptoms on CAPS and PCL-C, and these improvements were maintained through the 12-week follow-up, said Dr. Engel, who is also with the department of psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md. The mean PCL-C decreases were 19.4 at the end of treatment and 19.8 at the 12-week follow-up in the acupuncture group, compared with 4.0 and 9.7 in the usual care group. Cohen's d measures of effect sizes both before and after treatment and between groups were large (all greater than 1.0), he noted.

Symptoms of depression and pain also significantly improved in the acupuncture group, compared with the usual care group. The 36-Item Short Form Health Survey (SF-36) scores for mental functioning improved significantly with acupuncture. There was a trend toward improvement in physical functioning on the SF-36, but it likely didn't reach significance because the sample was fairly healthy physically and didn't have much room to improve, Dr. Engel said in an interview.

The investigators are interested in conducting a large multicenter trial that would involve a sham acupuncture arm in addition to the usual care and regular acupuncture arms examined in the current study.

VET-HEAL, a research program of the Samueli Institute for Information Biology, in Alexandria, Va., provided funding for the study. Dr. Engel reported no relevant conflicts of interest.

'This is the easiest trial in terms of recruitment. Patients were excited about this as a modality.' DR. ENGEL

CHICAGO — One of every nine men over age 59 years with a diagnosis of stroke or transient ischemic attack had an abdominal aortic aneurysm in a prospective study of 499 patients.

Among all patients admitted for stroke or TIA, the prevalence of abdominal aortic aneurysm (AAA) on ultrasound was 5.8%. This is comparable to that in other populations and was not significant.

AAA prevalence was 11.1% in a subgroup of 235 men aged 59 years and older (median 72 years), Dr. Niels H.A. Van Lindert and colleagues reported at the annual meeting of the Radiological Society of North America. The prevalence in the subgroup was significantly higher than the 4.0%-8.1% prevalence found in three recent population-based screening studies in men over 59 years of age.

The finding could lead to improved screening and earlier treatment of this high-risk group, said Dr. Van Lindert, of the Gelre Hospitals Apeldoorn (the Netherlands). Although the use of ultrasound is noninvasive, low-cost, accurate, and fast, most abdominal aneurysms are found by chance in men of older age and with a history of smoking.

“In our group, 55% of aneurysms were in nonsmokers, which meant that detection would not have occurred following task force rules,” he said.

The United States Preventive Services Task Force (USPSTF) recommends a one-time ultrasonography screening of all men aged 65-75 years with a history of smoking. The USPSTF makes no recommendation for or against screening for AAA in men aged 65-75 years who have never smoked, and recommends against routine screening for AAA in women.

Dr. Van Lindert recommended that all men older than 59 years of age admitted with a stroke or TIA should be screened for an AAA. Further studies are needed to determine the cost-benefit aspects of screening in this patient population with a shorter life expectancy, he said.

Abdominal aortic diameter was measured by ultrasonography in 518 patients (median age 71 years, 61% men) visiting their neurology department with a primary diagnosis of stroke or TIA between January 2002 and January 2005. In all, 373 had had an ischemic stroke, 125 a TIA, and 20 a cerebral hemorrhage.

An aneurysm was defined as an abdominal aorta with a diameter of at least 3.0 cm. Maximum diameter was 3.0-3.9 cm in 18 patients, 4.0-4.9 cm in 6 patients, and 5.0 cm or more in 5 patients.

The investigators found no association between AAA prevalence and cerebrovascular accident subtype or smoking, both of which have been previously identified as risk factors for AAA.

The investigators reported no conflicts of interest.

CHICAGO — One of every nine men over age 59 years with a diagnosis of stroke or transient ischemic attack had an abdominal aortic aneurysm in a prospective study of 499 patients.

Among all patients admitted for stroke or TIA, the prevalence of abdominal aortic aneurysm (AAA) on ultrasound was 5.8%. This is comparable to that in other populations and was not significant.

AAA prevalence was 11.1% in a subgroup of 235 men aged 59 years and older (median 72 years), Dr. Niels H.A. Van Lindert and colleagues reported at the annual meeting of the Radiological Society of North America. The prevalence in the subgroup was significantly higher than the 4.0%-8.1% prevalence found in three recent population-based screening studies in men over 59 years of age.

The finding could lead to improved screening and earlier treatment of this high-risk group, said Dr. Van Lindert, of the Gelre Hospitals Apeldoorn (the Netherlands). Although the use of ultrasound is noninvasive, low-cost, accurate, and fast, most abdominal aneurysms are found by chance in men of older age and with a history of smoking.

“In our group, 55% of aneurysms were in nonsmokers, which meant that detection would not have occurred following task force rules,” he said.

The United States Preventive Services Task Force (USPSTF) recommends a one-time ultrasonography screening of all men aged 65-75 years with a history of smoking. The USPSTF makes no recommendation for or against screening for AAA in men aged 65-75 years who have never smoked, and recommends against routine screening for AAA in women.

Dr. Van Lindert recommended that all men older than 59 years of age admitted with a stroke or TIA should be screened for an AAA. Further studies are needed to determine the cost-benefit aspects of screening in this patient population with a shorter life expectancy, he said.

Abdominal aortic diameter was measured by ultrasonography in 518 patients (median age 71 years, 61% men) visiting their neurology department with a primary diagnosis of stroke or TIA between January 2002 and January 2005. In all, 373 had had an ischemic stroke, 125 a TIA, and 20 a cerebral hemorrhage.

An aneurysm was defined as an abdominal aorta with a diameter of at least 3.0 cm. Maximum diameter was 3.0-3.9 cm in 18 patients, 4.0-4.9 cm in 6 patients, and 5.0 cm or more in 5 patients.

The investigators found no association between AAA prevalence and cerebrovascular accident subtype or smoking, both of which have been previously identified as risk factors for AAA.

The investigators reported no conflicts of interest.

CHICAGO — One of every nine men over age 59 years with a diagnosis of stroke or transient ischemic attack had an abdominal aortic aneurysm in a prospective study of 499 patients.

Among all patients admitted for stroke or TIA, the prevalence of abdominal aortic aneurysm (AAA) on ultrasound was 5.8%. This is comparable to that in other populations and was not significant.

AAA prevalence was 11.1% in a subgroup of 235 men aged 59 years and older (median 72 years), Dr. Niels H.A. Van Lindert and colleagues reported at the annual meeting of the Radiological Society of North America. The prevalence in the subgroup was significantly higher than the 4.0%-8.1% prevalence found in three recent population-based screening studies in men over 59 years of age.

The finding could lead to improved screening and earlier treatment of this high-risk group, said Dr. Van Lindert, of the Gelre Hospitals Apeldoorn (the Netherlands). Although the use of ultrasound is noninvasive, low-cost, accurate, and fast, most abdominal aneurysms are found by chance in men of older age and with a history of smoking.

“In our group, 55% of aneurysms were in nonsmokers, which meant that detection would not have occurred following task force rules,” he said.

The United States Preventive Services Task Force (USPSTF) recommends a one-time ultrasonography screening of all men aged 65-75 years with a history of smoking. The USPSTF makes no recommendation for or against screening for AAA in men aged 65-75 years who have never smoked, and recommends against routine screening for AAA in women.

Dr. Van Lindert recommended that all men older than 59 years of age admitted with a stroke or TIA should be screened for an AAA. Further studies are needed to determine the cost-benefit aspects of screening in this patient population with a shorter life expectancy, he said.

Abdominal aortic diameter was measured by ultrasonography in 518 patients (median age 71 years, 61% men) visiting their neurology department with a primary diagnosis of stroke or TIA between January 2002 and January 2005. In all, 373 had had an ischemic stroke, 125 a TIA, and 20 a cerebral hemorrhage.

An aneurysm was defined as an abdominal aorta with a diameter of at least 3.0 cm. Maximum diameter was 3.0-3.9 cm in 18 patients, 4.0-4.9 cm in 6 patients, and 5.0 cm or more in 5 patients.

The investigators found no association between AAA prevalence and cerebrovascular accident subtype or smoking, both of which have been previously identified as risk factors for AAA.

The investigators reported no conflicts of interest.

A related video is at www.youtube.com/InternalMedicineNews

CHICAGO — Breast-specific gamma imaging can detect additional breast cancers missed by mammography and physical examination in women with newly diagnosed breast cancer.

In a retrospective study in 159 women with at least one biopsy-proven cancer, follow-up breast-specific gamma imaging (BSGI) identified clinically and mammographically occult cancer in 14 of 45 lesions. Nine of the 14 occult cancers were in the same breast as the index lesion, Dr. Rachel F. Brem said at the annual meeting of the Radiological Society of North America.

“Surgical management is going to be dependent on whether there is one breast cancer or more than one cancer in that breast or in the other breast,” Dr. Brem told reporters at a press briefing. In at least one case, the discovery of an additional lesion meant that a mastectomy had to be performed rather than a lumpectomy as originally planned.

Unlike other adjunct imaging modalities such as mammography and ultrasound that image the physical structure of the breast, BSGI is a form of molecular imaging that captures the cellular functioning of the breast tissue through radiotracer uptake. Cancerous cells show increased radiotracer uptake because of their higher metabolic activity.

Previous studies using BSGI have shown that the technique improves cancer detection in high-risk women and can detect the earliest breast cancers, even those as small as 1 mm, said Dr. Brem, director of breast imaging and intervention, George Washington University, Washington.

Half of the cancers detected in the current study were less than 1 cm in diameter. They ranged in size from 0.1 cm to 3.6 cm, with a mean of 1.16 cm.

When asked by reporters how BSGI compares with other new molecular imaging modalities such as positron emission mammography (PEM), Dr. Brem said that the radiation dose with BSGI is at most half that of PEM and that BSGI can be performed at a “fraction of the cost” of PEM. A BSGI unit costs about $250,000 and the radiotracer costs about $75 per imaging study.

PEM also is difficult to perform in women with diabetes, as it utilizes radiated sugar, and it is approved for use only in women with known cancer, she said.

A BSGI study takes about 40 minutes and uses technetium 99-sestamibi, a radiotracer used for more than 15 years in cardiac stress testing. More than 80,000 women in the United States have been imaged with BSGI since it was approved in 1999. It is available in about 50 centers in the United States, Dr. Brem said.

The women in the study ranged in age from 29 to 93 years (mean 54 years); 12% had a personal history of cancer and 43% had a first-degree relative who had had breast cancer. Of note, 73% of the women had dense breasts.

Breast density is a significant limitation of mammographic breast cancer detection and is a strong independent risk factor for the development of breast cancer, said Dr. Brem, also a professor of radiology at the university. A recent study showed a four-to sixfold increased risk of detected breast cancer in women with mammographically dense breasts (N. Engl. J. Med. 2007;356:227-36).

Dr. Brem disclosed that she owned stock in and is a board member of Dilon Technologies, which makes the BSGI unit. She also has served on the board of directors for iCAD Inc. and was a consultant for Orbotech.

This image of a small cancer (dark circle) was obtained using BSGI. Radiological Society of North America

A related video is at www.youtube.com/InternalMedicineNews

CHICAGO — Breast-specific gamma imaging can detect additional breast cancers missed by mammography and physical examination in women with newly diagnosed breast cancer.

In a retrospective study in 159 women with at least one biopsy-proven cancer, follow-up breast-specific gamma imaging (BSGI) identified clinically and mammographically occult cancer in 14 of 45 lesions. Nine of the 14 occult cancers were in the same breast as the index lesion, Dr. Rachel F. Brem said at the annual meeting of the Radiological Society of North America.

“Surgical management is going to be dependent on whether there is one breast cancer or more than one cancer in that breast or in the other breast,” Dr. Brem told reporters at a press briefing. In at least one case, the discovery of an additional lesion meant that a mastectomy had to be performed rather than a lumpectomy as originally planned.

Unlike other adjunct imaging modalities such as mammography and ultrasound that image the physical structure of the breast, BSGI is a form of molecular imaging that captures the cellular functioning of the breast tissue through radiotracer uptake. Cancerous cells show increased radiotracer uptake because of their higher metabolic activity.

Previous studies using BSGI have shown that the technique improves cancer detection in high-risk women and can detect the earliest breast cancers, even those as small as 1 mm, said Dr. Brem, director of breast imaging and intervention, George Washington University, Washington.

Half of the cancers detected in the current study were less than 1 cm in diameter. They ranged in size from 0.1 cm to 3.6 cm, with a mean of 1.16 cm.

When asked by reporters how BSGI compares with other new molecular imaging modalities such as positron emission mammography (PEM), Dr. Brem said that the radiation dose with BSGI is at most half that of PEM and that BSGI can be performed at a “fraction of the cost” of PEM. A BSGI unit costs about $250,000 and the radiotracer costs about $75 per imaging study.

PEM also is difficult to perform in women with diabetes, as it utilizes radiated sugar, and it is approved for use only in women with known cancer, she said.

A BSGI study takes about 40 minutes and uses technetium 99-sestamibi, a radiotracer used for more than 15 years in cardiac stress testing. More than 80,000 women in the United States have been imaged with BSGI since it was approved in 1999. It is available in about 50 centers in the United States, Dr. Brem said.

The women in the study ranged in age from 29 to 93 years (mean 54 years); 12% had a personal history of cancer and 43% had a first-degree relative who had had breast cancer. Of note, 73% of the women had dense breasts.

Breast density is a significant limitation of mammographic breast cancer detection and is a strong independent risk factor for the development of breast cancer, said Dr. Brem, also a professor of radiology at the university. A recent study showed a four-to sixfold increased risk of detected breast cancer in women with mammographically dense breasts (N. Engl. J. Med. 2007;356:227-36).

Dr. Brem disclosed that she owned stock in and is a board member of Dilon Technologies, which makes the BSGI unit. She also has served on the board of directors for iCAD Inc. and was a consultant for Orbotech.

This image of a small cancer (dark circle) was obtained using BSGI. Radiological Society of North America

A related video is at www.youtube.com/InternalMedicineNews

CHICAGO — Breast-specific gamma imaging can detect additional breast cancers missed by mammography and physical examination in women with newly diagnosed breast cancer.

In a retrospective study in 159 women with at least one biopsy-proven cancer, follow-up breast-specific gamma imaging (BSGI) identified clinically and mammographically occult cancer in 14 of 45 lesions. Nine of the 14 occult cancers were in the same breast as the index lesion, Dr. Rachel F. Brem said at the annual meeting of the Radiological Society of North America.

“Surgical management is going to be dependent on whether there is one breast cancer or more than one cancer in that breast or in the other breast,” Dr. Brem told reporters at a press briefing. In at least one case, the discovery of an additional lesion meant that a mastectomy had to be performed rather than a lumpectomy as originally planned.

Unlike other adjunct imaging modalities such as mammography and ultrasound that image the physical structure of the breast, BSGI is a form of molecular imaging that captures the cellular functioning of the breast tissue through radiotracer uptake. Cancerous cells show increased radiotracer uptake because of their higher metabolic activity.

Previous studies using BSGI have shown that the technique improves cancer detection in high-risk women and can detect the earliest breast cancers, even those as small as 1 mm, said Dr. Brem, director of breast imaging and intervention, George Washington University, Washington.

Half of the cancers detected in the current study were less than 1 cm in diameter. They ranged in size from 0.1 cm to 3.6 cm, with a mean of 1.16 cm.

When asked by reporters how BSGI compares with other new molecular imaging modalities such as positron emission mammography (PEM), Dr. Brem said that the radiation dose with BSGI is at most half that of PEM and that BSGI can be performed at a “fraction of the cost” of PEM. A BSGI unit costs about $250,000 and the radiotracer costs about $75 per imaging study.

PEM also is difficult to perform in women with diabetes, as it utilizes radiated sugar, and it is approved for use only in women with known cancer, she said.

A BSGI study takes about 40 minutes and uses technetium 99-sestamibi, a radiotracer used for more than 15 years in cardiac stress testing. More than 80,000 women in the United States have been imaged with BSGI since it was approved in 1999. It is available in about 50 centers in the United States, Dr. Brem said.

The women in the study ranged in age from 29 to 93 years (mean 54 years); 12% had a personal history of cancer and 43% had a first-degree relative who had had breast cancer. Of note, 73% of the women had dense breasts.

Breast density is a significant limitation of mammographic breast cancer detection and is a strong independent risk factor for the development of breast cancer, said Dr. Brem, also a professor of radiology at the university. A recent study showed a four-to sixfold increased risk of detected breast cancer in women with mammographically dense breasts (N. Engl. J. Med. 2007;356:227-36).

Dr. Brem disclosed that she owned stock in and is a board member of Dilon Technologies, which makes the BSGI unit. She also has served on the board of directors for iCAD Inc. and was a consultant for Orbotech.

This image of a small cancer (dark circle) was obtained using BSGI. Radiological Society of North America

CHICAGO — A low ABCD2 score identified transient-ischemic-attack patients at low risk for having an early disabling stroke, but it was suboptimal at identifying more minor strokes in a prospective, multicenter study of 1,667 patients.

Early diffusion-weighted MRI (DWMRI) scanning was shown to add predictive value beyond that of the ABCD2 (Age, Blood Pressure, Clinical Features, Duration, Diabetes) score in identifying patients at low risk for an ischemic stroke within 90 days.

The negative predictive value of a low-risk score for predicting a stroke-free interval 7 days after a transient ischemic attack (TIA) was 86% for all strokes, compared with 99% for disabling strokes.

A total of 210 patients stratified as low risk according to an ABCD2 score of 3 or less underwent a DWMRI scan within 24 hours of TIA symptom onset. None of the 178 patients with a negative scan had a disabling stroke within 90 days (sensitivity 100%), Dr. Andrew W. Asimos and his associates reported in a poster presentation at the annual meeting of the American College of Emergency Physicians.

A medical record review revealed that a definitive stroke occurred within 90 days in 388 patients (23%), while a probable stroke occurred in an additional 10 patients. Of all strokes that occurred within 90 days, 19% were disabling.

“These results suggest that the ABCD2 score combined with early DWMRI scanning provides the best predictive value in identifying TIA in patients at low risk for an ischemic stroke,” said Dr. Asimos of Carolinas Medical Center, Charlotte, N.C.

The ABCD2 score, originally described in 2007 (Lancet 2007;369:283-92), has emerged as the preferred way to stratify TIA patients for early stroke risk.

Dr. Michelle Biros, professor of emergency medicine at the University of Minnesota, Minneapolis, said during a discussion that it was “somewhat concerning” that 3% of patients with a disabling stroke and 15% with a nondisabling stroke were stratified by an ABCD2 score as having low risk.

“This provides us with a measure of caution for using a scale that's easy to clinically apply,” she said. “Beyond the fact that the imaging is expensive and maybe doesn't add too much, the score isn't as useful as we had hoped.”

Limitations of the study were that not all patients received MRI imaging, patient follow-up was based on a medical record review, and missing data precluded calculation of a stratified ABCD2 score in 343 patients, Dr. Biros said.

Dr. Asimos said the study is the first multicenter attempt to validate the ABCD2 score outside of the population from which it was derived.

“If you only look at disabling stroke as an outcome measurement, a low-risk ABCD2 score does a pretty good job at predicting a low likelihood of disabling stroke within 90 days,” he said. “If patients are stratified as moderate to high risk based on an ABCD2 score, doing an early DWMRI will provide supplemental predictive value in identifying those patients who are truly at low risk for a disabling or nondisabling stroke.”

DWMRI imaging of the brain is highly sensitive for identifying infarction, but is also costly and time consuming, Dr. Asimos said in an interview.

The study was conducted at 16 North Carolina hospitals and enrolled patients with no prior stroke history and a presumptive admission diagnosis of TIA who presented within 24 hours of symptom onset. A total of 343 patients with missing data were excluded from the analysis.

A definitive stroke included infarction present on brain imaging, while a probable stroke was identified as a stroke diagnosis in the medical records without infarction on brain imaging. Strokes were classified as disabling or nondisabling based on a modified Rankin Scale Score dichotomized at less than 3 derived from the medical record review.

The investigators disclosed that the study was supported by the Emergency Medicine Foundation, the Foundation for Education in Neurological Emergencies, and Boehringer Ingelheim Pharmaceuticals.

CHICAGO — A low ABCD2 score identified transient-ischemic-attack patients at low risk for having an early disabling stroke, but it was suboptimal at identifying more minor strokes in a prospective, multicenter study of 1,667 patients.

Early diffusion-weighted MRI (DWMRI) scanning was shown to add predictive value beyond that of the ABCD2 (Age, Blood Pressure, Clinical Features, Duration, Diabetes) score in identifying patients at low risk for an ischemic stroke within 90 days.

The negative predictive value of a low-risk score for predicting a stroke-free interval 7 days after a transient ischemic attack (TIA) was 86% for all strokes, compared with 99% for disabling strokes.

A total of 210 patients stratified as low risk according to an ABCD2 score of 3 or less underwent a DWMRI scan within 24 hours of TIA symptom onset. None of the 178 patients with a negative scan had a disabling stroke within 90 days (sensitivity 100%), Dr. Andrew W. Asimos and his associates reported in a poster presentation at the annual meeting of the American College of Emergency Physicians.

A medical record review revealed that a definitive stroke occurred within 90 days in 388 patients (23%), while a probable stroke occurred in an additional 10 patients. Of all strokes that occurred within 90 days, 19% were disabling.

“These results suggest that the ABCD2 score combined with early DWMRI scanning provides the best predictive value in identifying TIA in patients at low risk for an ischemic stroke,” said Dr. Asimos of Carolinas Medical Center, Charlotte, N.C.

The ABCD2 score, originally described in 2007 (Lancet 2007;369:283-92), has emerged as the preferred way to stratify TIA patients for early stroke risk.

Dr. Michelle Biros, professor of emergency medicine at the University of Minnesota, Minneapolis, said during a discussion that it was “somewhat concerning” that 3% of patients with a disabling stroke and 15% with a nondisabling stroke were stratified by an ABCD2 score as having low risk.

“This provides us with a measure of caution for using a scale that's easy to clinically apply,” she said. “Beyond the fact that the imaging is expensive and maybe doesn't add too much, the score isn't as useful as we had hoped.”

Limitations of the study were that not all patients received MRI imaging, patient follow-up was based on a medical record review, and missing data precluded calculation of a stratified ABCD2 score in 343 patients, Dr. Biros said.

Dr. Asimos said the study is the first multicenter attempt to validate the ABCD2 score outside of the population from which it was derived.

“If you only look at disabling stroke as an outcome measurement, a low-risk ABCD2 score does a pretty good job at predicting a low likelihood of disabling stroke within 90 days,” he said. “If patients are stratified as moderate to high risk based on an ABCD2 score, doing an early DWMRI will provide supplemental predictive value in identifying those patients who are truly at low risk for a disabling or nondisabling stroke.”

DWMRI imaging of the brain is highly sensitive for identifying infarction, but is also costly and time consuming, Dr. Asimos said in an interview.

The study was conducted at 16 North Carolina hospitals and enrolled patients with no prior stroke history and a presumptive admission diagnosis of TIA who presented within 24 hours of symptom onset. A total of 343 patients with missing data were excluded from the analysis.

A definitive stroke included infarction present on brain imaging, while a probable stroke was identified as a stroke diagnosis in the medical records without infarction on brain imaging. Strokes were classified as disabling or nondisabling based on a modified Rankin Scale Score dichotomized at less than 3 derived from the medical record review.

The investigators disclosed that the study was supported by the Emergency Medicine Foundation, the Foundation for Education in Neurological Emergencies, and Boehringer Ingelheim Pharmaceuticals.

CHICAGO — A low ABCD2 score identified transient-ischemic-attack patients at low risk for having an early disabling stroke, but it was suboptimal at identifying more minor strokes in a prospective, multicenter study of 1,667 patients.

Early diffusion-weighted MRI (DWMRI) scanning was shown to add predictive value beyond that of the ABCD2 (Age, Blood Pressure, Clinical Features, Duration, Diabetes) score in identifying patients at low risk for an ischemic stroke within 90 days.

The negative predictive value of a low-risk score for predicting a stroke-free interval 7 days after a transient ischemic attack (TIA) was 86% for all strokes, compared with 99% for disabling strokes.

A total of 210 patients stratified as low risk according to an ABCD2 score of 3 or less underwent a DWMRI scan within 24 hours of TIA symptom onset. None of the 178 patients with a negative scan had a disabling stroke within 90 days (sensitivity 100%), Dr. Andrew W. Asimos and his associates reported in a poster presentation at the annual meeting of the American College of Emergency Physicians.

A medical record review revealed that a definitive stroke occurred within 90 days in 388 patients (23%), while a probable stroke occurred in an additional 10 patients. Of all strokes that occurred within 90 days, 19% were disabling.

“These results suggest that the ABCD2 score combined with early DWMRI scanning provides the best predictive value in identifying TIA in patients at low risk for an ischemic stroke,” said Dr. Asimos of Carolinas Medical Center, Charlotte, N.C.

The ABCD2 score, originally described in 2007 (Lancet 2007;369:283-92), has emerged as the preferred way to stratify TIA patients for early stroke risk.

Dr. Michelle Biros, professor of emergency medicine at the University of Minnesota, Minneapolis, said during a discussion that it was “somewhat concerning” that 3% of patients with a disabling stroke and 15% with a nondisabling stroke were stratified by an ABCD2 score as having low risk.

“This provides us with a measure of caution for using a scale that's easy to clinically apply,” she said. “Beyond the fact that the imaging is expensive and maybe doesn't add too much, the score isn't as useful as we had hoped.”

Limitations of the study were that not all patients received MRI imaging, patient follow-up was based on a medical record review, and missing data precluded calculation of a stratified ABCD2 score in 343 patients, Dr. Biros said.

Dr. Asimos said the study is the first multicenter attempt to validate the ABCD2 score outside of the population from which it was derived.

“If you only look at disabling stroke as an outcome measurement, a low-risk ABCD2 score does a pretty good job at predicting a low likelihood of disabling stroke within 90 days,” he said. “If patients are stratified as moderate to high risk based on an ABCD2 score, doing an early DWMRI will provide supplemental predictive value in identifying those patients who are truly at low risk for a disabling or nondisabling stroke.”

DWMRI imaging of the brain is highly sensitive for identifying infarction, but is also costly and time consuming, Dr. Asimos said in an interview.

The study was conducted at 16 North Carolina hospitals and enrolled patients with no prior stroke history and a presumptive admission diagnosis of TIA who presented within 24 hours of symptom onset. A total of 343 patients with missing data were excluded from the analysis.

A definitive stroke included infarction present on brain imaging, while a probable stroke was identified as a stroke diagnosis in the medical records without infarction on brain imaging. Strokes were classified as disabling or nondisabling based on a modified Rankin Scale Score dichotomized at less than 3 derived from the medical record review.

The investigators disclosed that the study was supported by the Emergency Medicine Foundation, the Foundation for Education in Neurological Emergencies, and Boehringer Ingelheim Pharmaceuticals.

CHICAGO – Young children experience traumatic stress reactions after a burn injury but also appear to be at risk of comorbid disorders, preliminary findings from a study in 135 children show.

The study used two criteria to evaluate posttraumatic stress disorder (PTSD) because several studies have shown that the DSM-IV nosology for PTSD does not adequately capture many of the symptoms experienced by young traumatized children. In one of those studies, Dr. Michael S. Scheeringa of the neuroscience program at Tulane University, New Orleans, proposed an alternative algorithm for use in infants and children younger than 4 years of age (J. Am. Acad. Child Adolesc. Psychiatry 1995;34:191-200).

In the current study, all of the children (aged 1–6 years) were unintentionally burned. Data are available for 36 boys and 31 girls (mean age 2 years and 2 months) and for 63 mothers and 4 fathers, who participated in structured clinical interviews conducted over the telephone.

At the 4- to 6-week assessment, 17% of the children met conditions for a diagnosis of PTSD based on the alternative algorithm criteria, and 9% met the criteria for this diagnosis at the 6-month follow-up.

In contrast, 6% of children met the DSM-IV criteria for a diagnosis of PTSD at the 4- to 6-month assessment and none did so at 6 months, principal investigator Alexandra De Young and her associates reported in a poster at the annual meeting of the International Society for Traumatic Stress Studies.

“The DSM-IV PTSD criteria need to be modified to ensure that it is developmentally sensitive for infants, toddlers and preschoolers,” the investigators wrote.

The prevalence rate for PTSD is comparable with other studies that have used Dr. Scheeringa's alternative PTSD algorithm with young injured children, reported Ms. De Young, a psychologist and PhD candidate with the Centre of National Research on Disability and Rehabilitation Medicine and the School of Psychology, University of Queensland (Australia).

What was striking in the study were the prevalence rates for oppositional defiant disorder (ODD) and separation anxiety disorder (SAD)–both of which were higher than that found in previously published community samples.

ODD was present in 12% of the children at the first assessment and in 11% at 6 months; SAD was present in 11% and 4%, respectively. “This is a particular concern, given symptoms appear to persist over the first 6 months,” the investigators wrote.

Depressive symptoms were present in 5% of the children at the first assessment but were not identified at 6 months. Parents reported that clingy or aggressive behavior was experienced by 62% of children at the first assessment and by 37% at 6 months.

Parents also reported experiencing high levels of distress. When assessed 1 month after the accident using the Posttraumatic Stress Diagnostic Scale, 23% of parents were positive for PTSD, with 27% experiencing moderate to severe symptoms. Although this was reduced by 6 months, 11% continued to experience significant distress in relation to their child's accident.

“Heath care providers need to be aware that young children can be affected by burns, and this needs to be considered within the family context,” the investigators concluded at the meeting cosponsored by Boston University.

Support for the study was provided by the Crestbrook Committee through the Royal Children's Hospital Foundation Postgraduate Scholarship. The investigators disclosed no relevant conflicts of interest.

CHICAGO – Young children experience traumatic stress reactions after a burn injury but also appear to be at risk of comorbid disorders, preliminary findings from a study in 135 children show.

The study used two criteria to evaluate posttraumatic stress disorder (PTSD) because several studies have shown that the DSM-IV nosology for PTSD does not adequately capture many of the symptoms experienced by young traumatized children. In one of those studies, Dr. Michael S. Scheeringa of the neuroscience program at Tulane University, New Orleans, proposed an alternative algorithm for use in infants and children younger than 4 years of age (J. Am. Acad. Child Adolesc. Psychiatry 1995;34:191-200).

In the current study, all of the children (aged 1–6 years) were unintentionally burned. Data are available for 36 boys and 31 girls (mean age 2 years and 2 months) and for 63 mothers and 4 fathers, who participated in structured clinical interviews conducted over the telephone.

At the 4- to 6-week assessment, 17% of the children met conditions for a diagnosis of PTSD based on the alternative algorithm criteria, and 9% met the criteria for this diagnosis at the 6-month follow-up.

In contrast, 6% of children met the DSM-IV criteria for a diagnosis of PTSD at the 4- to 6-month assessment and none did so at 6 months, principal investigator Alexandra De Young and her associates reported in a poster at the annual meeting of the International Society for Traumatic Stress Studies.

“The DSM-IV PTSD criteria need to be modified to ensure that it is developmentally sensitive for infants, toddlers and preschoolers,” the investigators wrote.

The prevalence rate for PTSD is comparable with other studies that have used Dr. Scheeringa's alternative PTSD algorithm with young injured children, reported Ms. De Young, a psychologist and PhD candidate with the Centre of National Research on Disability and Rehabilitation Medicine and the School of Psychology, University of Queensland (Australia).

What was striking in the study were the prevalence rates for oppositional defiant disorder (ODD) and separation anxiety disorder (SAD)–both of which were higher than that found in previously published community samples.

ODD was present in 12% of the children at the first assessment and in 11% at 6 months; SAD was present in 11% and 4%, respectively. “This is a particular concern, given symptoms appear to persist over the first 6 months,” the investigators wrote.

Depressive symptoms were present in 5% of the children at the first assessment but were not identified at 6 months. Parents reported that clingy or aggressive behavior was experienced by 62% of children at the first assessment and by 37% at 6 months.

Parents also reported experiencing high levels of distress. When assessed 1 month after the accident using the Posttraumatic Stress Diagnostic Scale, 23% of parents were positive for PTSD, with 27% experiencing moderate to severe symptoms. Although this was reduced by 6 months, 11% continued to experience significant distress in relation to their child's accident.

“Heath care providers need to be aware that young children can be affected by burns, and this needs to be considered within the family context,” the investigators concluded at the meeting cosponsored by Boston University.

Support for the study was provided by the Crestbrook Committee through the Royal Children's Hospital Foundation Postgraduate Scholarship. The investigators disclosed no relevant conflicts of interest.

CHICAGO – Young children experience traumatic stress reactions after a burn injury but also appear to be at risk of comorbid disorders, preliminary findings from a study in 135 children show.

The study used two criteria to evaluate posttraumatic stress disorder (PTSD) because several studies have shown that the DSM-IV nosology for PTSD does not adequately capture many of the symptoms experienced by young traumatized children. In one of those studies, Dr. Michael S. Scheeringa of the neuroscience program at Tulane University, New Orleans, proposed an alternative algorithm for use in infants and children younger than 4 years of age (J. Am. Acad. Child Adolesc. Psychiatry 1995;34:191-200).

In the current study, all of the children (aged 1–6 years) were unintentionally burned. Data are available for 36 boys and 31 girls (mean age 2 years and 2 months) and for 63 mothers and 4 fathers, who participated in structured clinical interviews conducted over the telephone.

At the 4- to 6-week assessment, 17% of the children met conditions for a diagnosis of PTSD based on the alternative algorithm criteria, and 9% met the criteria for this diagnosis at the 6-month follow-up.

In contrast, 6% of children met the DSM-IV criteria for a diagnosis of PTSD at the 4- to 6-month assessment and none did so at 6 months, principal investigator Alexandra De Young and her associates reported in a poster at the annual meeting of the International Society for Traumatic Stress Studies.

“The DSM-IV PTSD criteria need to be modified to ensure that it is developmentally sensitive for infants, toddlers and preschoolers,” the investigators wrote.

The prevalence rate for PTSD is comparable with other studies that have used Dr. Scheeringa's alternative PTSD algorithm with young injured children, reported Ms. De Young, a psychologist and PhD candidate with the Centre of National Research on Disability and Rehabilitation Medicine and the School of Psychology, University of Queensland (Australia).

What was striking in the study were the prevalence rates for oppositional defiant disorder (ODD) and separation anxiety disorder (SAD)–both of which were higher than that found in previously published community samples.

ODD was present in 12% of the children at the first assessment and in 11% at 6 months; SAD was present in 11% and 4%, respectively. “This is a particular concern, given symptoms appear to persist over the first 6 months,” the investigators wrote.

Depressive symptoms were present in 5% of the children at the first assessment but were not identified at 6 months. Parents reported that clingy or aggressive behavior was experienced by 62% of children at the first assessment and by 37% at 6 months.

Parents also reported experiencing high levels of distress. When assessed 1 month after the accident using the Posttraumatic Stress Diagnostic Scale, 23% of parents were positive for PTSD, with 27% experiencing moderate to severe symptoms. Although this was reduced by 6 months, 11% continued to experience significant distress in relation to their child's accident.

“Heath care providers need to be aware that young children can be affected by burns, and this needs to be considered within the family context,” the investigators concluded at the meeting cosponsored by Boston University.

Support for the study was provided by the Crestbrook Committee through the Royal Children's Hospital Foundation Postgraduate Scholarship. The investigators disclosed no relevant conflicts of interest.