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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2002;162:1546.
Predictive Factors of Malaria in Travelers to Areas Where Malaria Is
Endemic
For a 4-year period, 783 patients had malaria smears collected for suspected
malaria; 145 patients had a diagnosis of malaria. In multivariate analysis,
the factors predictive of malaria were a visit to sub-Saharan Africa (odds
ratio [OR], 7.7; 95% confidence interval [CI], 2.8-21.3), temperature of 38.5°C
or higher (OR, 6.2; 95% CI, 2.8-13.3), chills (OR, 3; 95% CI, 1.4-6.6), thrombocytopenia
(OR, 16.5; 95% CI, 7.1-38.3), and abnormally high total bilirubin level (OR,
21.5; 95% CI, 6.4-72.5). However, singly or combined, these features had insufficient
sensitivity (95%) and low specificity (55%) for a diagnosis of malaria. The
authors conclude that all patients presenting with complaints after travel
to a malaria-endemic area should be suspected of having malaria and should
undergo blood microscopy.
(SEE ARTICLE)
The Outcomes and Costs of Acute Myeloid Leukemia Among the Elderly
Using a retrospective inception cohort design and data from a linkage
between the SEER cancer registry data and Medicare claims data, Menzin and
colleagues evaluated outcomes among adults 65 years and older with newly diagnosed
acute myeloid leukemia. The prognosis for acute myeloid leukemia was poor,
with median survival estimated to be 2 months and a 2-year survival rate of
6%. Average expenditures for these patients were substantial (exceeding $40 000).
A minority of patients underwent chemotherapy treatment (30%), and the use
of hospice care was rare (17% of cases). Further work is needed to characterize
this disease and the patient-related factors that influence treatment decisions
and associated health outcomes.
(SEE ARTICLE)
Use of a Clinical Decision Rule in Combination With D-Dimer Concentration
in Diagnostic Workup of Patients With Suspected Pulmonary Embolism: A Prospective
Management Study
Every year, 2 to 3 per 1000 inhabitants present with suspected pulmonary
embolism. The available diagnostic algorithms often consist of complex and
multi-imaging tests. In this prospective study in 234 patients, Kruip et al
evaluated the safety of withholding anticoagulant treatment in patients presenting
with suspected pulmonary embolism, who have a low clinical probability assessment
and a normal D-dimer concentration. This combination is a rapid and cost-effective
method to exclude pulmonary embolism safely and is readily accepted.
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PE indicates pulmonary embolism; CUS, compression ultrasonography.
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(SEE ARTICLE)
The New Definition of Myocardial Infarction: Diagnostic and Prognostic
Implications in Patients With Acute Coronary Syndromes
Meier et al evaluated 493 consecutive patients with suspected acute
coronary syndromes to determine the diagnostic and prognostic implications
of the recently changed new definition of acute myocardial infarction (AMI)
per the American College of Cardiology and European Society of Cardiology.
Patients with AMI were stratified into 2 groups. Group A consisted of patients
diagnosed as having AMI by the World Health Organization criteria that include
2 of the following 3: ischemic symptoms, electrocardiogram suggestive of a
new ST-segment elevation AMI, and an elevated creatine kinase–MB fraction
(CK-MB) level. Group B included patients with only an elevated troponin level
in absence of an elevated CK-MB level and thus were diagnosed as having AMI
only by the new criteria. The data of Meier et al suggested that more patients
with acute coronary syndromes are diagnosed as having AMI by the new criteria.
Further, these additional patients diagnosed as having AMI are no less sick
than those diagnosed as having AMI by old criteria and as a result have worse
6-month outcomes. Thus, the new criteria for AMI diagnosis incorporate meaningful
additional risk stratification information over and above that provided by
the old definition.
(SEE ARTICLE)
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