Risk factors associated with complex inferior vena cava filter retrievals and complications: A 7-year retrieval database analysis and the impact on retrieval rates at an Australian tertiary centre.

INTRODUCTION: Venous thromboembolism (VTE) affects approximately 17,000 Australians annually. While anticoagulation is the mainstay of treatment, inferior vena cava filters (IVCFs) are used in patients where this is contraindicated. The primary aim was to identify risk factors for complex retrievals and IVCF-related complications following the establishment of a database at a single tertiary centre. The secondary aim was to evaluate the IVCF retrieval rate and patients lost to follow-up. METHODS: A retrospective study at a single tertiary centre was conducted on IVCFs inserted from 2012 to 2018. Logistic regression models were used to evaluate potential risk factors for filter-related complications and complex retrievals. RESULTS: In total, 402 patients had an IVCF inserted. Of these, 308 patients (77%) had a retrieval attempted, 10 (3%) of which required more than one retrieval attempt (complex retrieval). Factors associated with filter-related complications included dwell time (OR 1.02, 95% CI: 1.01-1.04) and select indications for insertion, namely VTE requiring thrombolysis/thrombectomy (OR 2.29, 95% CI: 1.02-5.16) and iliocaval/free-floating iliofemoral DVT without thrombectomy/thrombolysis (OR 5.89, 95% CI: 1.53-22.71). After mutual adjustment for all variables, only dwell time remained a significant factor for filter-related complications (adjusted OR 1.03, 95% CI: 1.01-1.05) and complex retrieval (AOR 1.05, 95% CI: 1.02-1.08). The annual retrieval rate increased from 73% (2012) to 83% (2018), with an overall retrieval rate of 75%. CONCLUSION: Dwell time is a potential risk factor for filter-related complications and complex retrievals. The annual IVCF retrieval rate was 75% since an Interventional Radiology-led database was established.

Chest radiographs for acute lower respiratory tract infections.

BACKGROUND: Acute lower respiratory tract infections (LRTIs) (e.g. pneumonia) are a major cause of morbidity and mortality and management focuses on early treatment. Chest radiographs (X-rays) are one of the commonly used strategies. Although radiological facilities are easily accessible in high-income countries, access can be limited in low-income countries. The efficacy of chest radiographs as a tool in the management of acute LRTIs has not been determined. Although chest radiographs are used for both diagnosis and management, our review focuses only on management. OBJECTIVES: To assess the effectiveness of chest radiographs in addition to clinical judgement, compared to clinical judgement alone, in the management of acute LRTIs in children and adults. SEARCH METHODS: We searched CENTRAL 2013, Issue 1; MEDLINE (1948 to January week 4, 2013); EMBASE (1974 to February 2013); CINAHL (1985 to February 2013) and LILACS (1985 to February 2013). We also searched NHS EED, DARE, ClinicalTrials.gov and WHO ICTRP (up to February 2013). SELECTION CRITERIA: Randomised controlled trials (RCTs) of chest radiographs versus no chest radiographs in acute LRTIs in children and adults. DATA COLLECTION AND ANALYSIS: Two review authors independently applied the inclusion criteria, extracted data and assessed risk of bias. A third review author compiled the findings and any discrepancies were discussed among all review authors. We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: Two RCTs involving 2024 patients (1502 adults and 522 children) were included in this review. Both RCTs excluded patients with suspected severe disease. It was not possible to pool the results due to incomplete data. Both included trials concluded that the use of chest radiographs did not result in a better clinical outcome (duration of illness and of symptoms) for patients with acute LRTIs. In the study involving children in South Africa, the median time to recovery was seven days (95% confidence interval (CI) six to eight days (radiograph group) and six to nine days (control group)), P value = 0.50, log-rank test) and the hazard ratio for recovery was 1.08 (95% CI 0.85 to 1.34). In the study with adult participants in the USA, the average duration of illness was 16.9 days versus 17.0 days (P value > 0.05) in the radiograph and no radiograph groups respectively. This result was not statistically significant and there were no significant differences in patient outcomes between the groups with or without chest radiograph.The study in adults also reports that chest radiographs did not affect the frequencies with which clinicians ordered return visits or antibiotics. However, there was a benefit of chest radiographs in a subgroup of the adult participants with an infiltrate on their radiograph, with a reduction in length of illness (16.2 days in the group allocated to chest radiographs and 22.6 in the non-chest radiograph group, P < 0.05), duration of cough (14.2 versus 21.3 days, P < 0.05) and duration of sputum production (8.5 versus 17.8 days, P < 0.05). The authors mention that this difference in outcome between the intervention and control group in this particular subgroup only was probably a result of "the higher proportion of patients treated with antibiotics when the radiograph was used in patient care".Hospitalisation rates were only reported in the study involving children and it was found that a higher proportion of patients in the radiograph group (4.7%) required hospitalisation compared to the control group (2.3%) with the result not being statistically significant (P = 0.14). None of the trials report the effect on mortality, complications of infection or adverse events from chest radiographs. Overall, the included studies had a low or unclear risk for blinding, attrition bias and reporting bias, but a high risk of selection bias. Both trials had strict exclusion criteria which is important but may limit the clinical practicability of the results as participants may not reflect those presenting in clinical practice. AUTHORS' CONCLUSIONS: Data from two trials suggest that routine chest radiography does not affect the clinical outcomes in adults and children presenting to a hospital with signs and symptoms suggestive of a LRTI. This conclusion may be weakened by the risk of bias of the studies and the lack of complete data available.