The impact of data quality defects on clinical decision-making in the intensive care unit.

OBJECTIVE: Poor clinical data quality might affect clinical decision making and patient treatment. This study identifies quality defects in clinical data collected automatically by bedside monitoring devices in the Intensive Care Unit (ICU) and examines their effect on clinical decisions. METHODS: Real-world data collected from 7688 patients admitted to the general ICU in a tertiary referral hospital over seven years was retrospectively analyzed. Data quality defect detection methods that use time-series analysis techniques identified two types of data quality defects: (a) completeness: the extent of non-missing values, and (b) validity: the extent of non-extreme values within the continuous range of values. Data quality defects were compared to five scenarios of medication and procedure prescriptions that are common in ICU settings: Blood-pressure reduction, blood-pressure elevation, anesthesia medications, intubation procedures, and muscle relaxant medications. RESULTS: Results from a logistic regression revealed a strong connection between data quality and the clinical interventions examined: lower validity level increased the likelihood of prescription decisions for all five scenarios, and lower completeness level increased the likelihood of prescription decisions for some scenarios. DISCUSSION: The results highlight the possible effect of data quality defects on physicians' decisions. Lower validity of certain key clinical parameters, and in some scenarios lower completeness, correlated with stronger tendency to prescribe medications or perform invasive procedures. CONCLUSIONS: Data quality defects in clinical data affect decision making even without practitioners' awareness. Thus, it is important to emphasize these effects to ICU staff, as well as to medical device manufacturers.

A double-plating approach to distal femur fracture: A clinical study.

BACKGROUND: Locked plating is one of the latest innovative options for treating supracondylar femur fractures with relatively low failure rates. Single lateral plating was often found to have a relative higher failure rate. No clinical studies of double-plating distal femur fixation have thus far been reported. The aim of this study is to present our clinical experience with this surgical approach. PATIENTS AND METHODS: Thirty-two patients (26 females and 6 males, mean age 76 years, range 44-101) were included in the study. Eight of them patients had a periprosthetic stable implant fracture and two patients were treated for a nonunion. RESULTS: All fractures, excluding one that needed bone grafting and one refracture, healed within 12 weeks. One patient needed bone grafting for delayed union and one patient needed fixation exchange due to femur re-fracture at the site of the most proximal screw. Two patients developed superficial wound infection and one patient required medial plate removal after union due to deep infection. CONCLUSIONS: Based on these promising results, we propose that the double-plating technique should be considered in the surgeon's armamentarium for the treatment of supracondylar femur fractures, particularly in patients with poor bone quality, comminuted fractures and very low periprosthetic fractures.

Corona mortis anastomosis: a three-dimensional computerized tomographic angiographic study.

PURPOSE: We evaluated the corona mortis (CM) anatomy by means of three-dimensional computerized tomography angiographic (CTA). METHODS: Patient demographic, anastomosis incidence, artery diameter, artery distance from the symphysis pubis, and pelvic size (distance between both acetabular upper labrum) parameters were assessed. The 100 patients included 66 males and 34 females (average age of 67.8 years). RESULTS: There were 66 (33%) arterial anastomoses in the 200 evaluated arteries, 30 in the right side and 36 in the left side, 36 unilaterally and 15 bilaterally. No anastomoses were detected in 49 patients. The average diameter was 2.4 mm for the right-sided arteries and 2.24 in the left-sided ones. The distance was 55.2 mm from the right symphysis and 57.2 from the left symphysis (greater for females, 62.2 versus 55.85 mm [p = 0.037] only on the left side). The artery disappears in smaller-sized pelvises. There was a non-occluded arterial pattern in 47 (71%) and a partially occluded one in 19 (29%, all with peripheral vascular disease). CONCLUSION: One-third of the evaluated CTAs revealed competent CMs. CMs were more lateral in females than in males and were absent in small-sized pelvises. It is highly recommended that the radiologist and the surgeon should be familiar with CM existence for decision-making with regard to emergency radiology imaging and intervention as well as when operating in proximity of that anatomic site.