title: Screening for abdominal aortic aneurysm with electronic clinical reminders.
abstract: 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.
authors.affiliation: Section of Vascular Surgery, VA New Jersey Health Care System, East Orange, NJ 07103, USA. Frank.padberg@med.va.gov
authors.forename: Frank T
authors.initials: FT
authors.lastname: Padberg
authors.forename: Karen
authors.initials: K
authors.lastname: Hauck
authors.forename: Richard G
authors.initials: RG
authors.lastname: Mercer
authors.forename: B K
authors.initials: BK
authors.lastname: Lal
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pappas
mesh_terms: 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