Screening for abdominal aortic aneurysm with electronic clinical reminders.
BACKGROUND
Based on randomized, population-based screening protocols, a single ultrasound examination reduces mortality from an abdominal aortic aneurysm (AAA) by facilitating elective surgical intervention before rupture. Ultrasound screening is accurate, noninvasive, inexpensive, and cost effective. By using a comprehensive electronic medical record, we inquired whether an age-prompted clinical reminder would facilitate the detection of AAA.


METHODS
The AAA risk screen was installed in May 2007 via a computerized patient record system prompt for male veterans ages 65 to 75 who ever smoked. This abbreviated ultrasound examination uses a 3.5- to 4-MHz scan head, measures anteroposterior and transverse planes, and reports the largest infrarenal aortic diameter.


RESULTS
Of 1437 examinations there were 73 AAAs of 3.0-cm diameter or larger (5.1%); 33 AAAs of 4.0-cm diameter or larger (2.3%); 15 AAAs of 5.0-cm diameter or larger (1.0%); and 11 AAAs of 5.5-cm diameter or larger (.77%). Fifty (68%) received counseling for abnormal findings.


CONCLUSIONS
Recognition of newly diagnosed AAA compared favorably with that of previous screening studies. Electronic clinical reminders identify undiagnosed, life-threatening AAAs before rupture. Immediate counseling is available in the vascular setting.
Padberg
Frank T
FT
Section of Vascular Surgery, VA New Jersey Health Care System, East Orange, NJ 07103, USA. Frank.padberg@med.va.gov
Hauck
Karen
K
Mercer
Richard G
RG
Lal
B K
BK
Pappas
Peter J
PJ
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging*; D001019:Aortic Rupture / Q000517:prevention & control; D057286:Electronic Health Records; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D017010:Reminder Systems; D018570:Risk Assessment; D014463:Ultrasonography; D014481:United States; D014728:Veterans