Search results for "Emergency Service"
showing 10 items of 86 documents
Clinical Evaluation Versus Undetectable High-Sensitivity Troponin for Assessment of Patients With Acute Chest Pain.
2016
Decision-making in acute chest pain remains challenging despite normal (below ninety-ninth percentile) high-sensitivity troponin (hs-cTn). Some studies suggest that undetectable hs-cTn, far below the ninety-ninth percentile, might rule out acute coronary syndrome. We investigated clinical data in comparison to undetectable hs-cTnT. The study comprised 682 patients (November 2010 to September 2011) presenting at the emergency department with chest pain and normal hs-cTnT (14 ng/l). The main end point was major adverse cardiac events (MACE: death, myocardial infarction, readmission for unstable angina, or revascularization) at a 4-year median follow-up; secondary end point was 30-day MACE. A …
Multicentric study on the beta-blocker use and relation with exacerbations in COPD
2014
SummaryChronic obstructive pulmonary disease (COPD) is frequently associated with chronic heart failure (CHF) or coronary artery disease (CAD). In spite of the recommendation to use beta-blockers (BB) they are likely under-prescribed to patients with concurrent COPD and heart diseases. To find out the prevalence of use of BB, 256 COPD patients were consecutively recruited by pulmonary physicians from 14 hospitals in 7 regions of Spain in their outpatient offices if they had a diagnosis of COPD, were not on long-term oxygen therapy, had CHF or CAD, and met the criteria for BB treatment.In patients with indication 58% (95%CI, 52–64%) of the COPD patients and 97% of the non-COPD patients were …
Limitations of Clinical History for Evaluation of Patients With Acute Chest Pain, Non-Diagnostic Electrocardiogram, and Normal Troponin
2007
Decision making and risk stratification for patients with acute chest pain, nondiagnostic electrocardiogram results, and normal troponin levels are challenging. The aim of this study was to optimize the clinical history for the evaluation of these patients. A total of 1,011 patients presenting to an emergency department were included. The following data were collected: clinical presentation (pain characteristics and number of pain episodes), coronary risk factors, previous ischemic heart disease, and extracardiac vascular disease (peripheral artery disease, stroke, or creatinine >1.4 mg/dl). Two different predictive models were calculated according to the end points: model 1 for 1-year majo…
Is high-sensitivity troponin, alone or in combination with copeptin, sensitive enough for ruling out NSTEMI in very early presenters at admission? A …
2019
Objectives: Copeptin and high-sensitivity cardiac troponin (HS-cTn) assays improve the early detection of non-ST-segment elevation myocardial infarction (NSTEMI). Their sensitivities may, however, be reduced in very early presenters.Setting: We performed a post hoc analysis of three prospective studies that included patients who presented to the emergency department for chest pain onset (CPO) of less than 6 hours.Participants: 449 patients were included, in whom 12% had NSTEMI. CPO occurred 4 hours in 146 patients. The prevalence of NSTEMI was similar in all groups (9%, 13% and 12%, respectively, p=0.281).Measures: Diagnostic performances of HS-cTn and copeptin at presentation were examined…
Is functional mobility an independent mortality risk factor in subjects with dementia?
2017
Abstract Objective To investigate whether functional mobility is a predictor of 12-month mortality in elderly subjects with dementia. Study design Prospective multicentre study performed in nine French university hospitals. Patients aged 75 years or more and hospitalised in medical wards via the emergency department were eligible. Those with a diagnosis of dementia were considered in the analyses. Main outcome measures Patients’ characteristics obtained through comprehensive geriatric assessment performed during the first week of hospitalisation. Functional mobility was assessed using the timed “Up & Go” test. The main outcome was time to death within the 12 months of follow-up. Bivariable …
Relationship between low lymphocyte count and major cardiac events in patients with acute chest pain, a non-diagnostic electrocardiogram and normal t…
2008
Risk stratification of patients with acute chest pain, non-diagnostic electrocardiogram and normal troponin (ACPneg) remains a challenge, partly because no standardized set of biomarkers with prognostic ability has been identified in this population. Lymphopenia has been associated with atherosclerosis progression and adverse outcomes in cardiovascular diseases; although its prognostic value in ACPneg is unknown. We sought to determine the relationship between the lymphocyte count obtained in the Emergency Department (ED) and the risk of the long-term all-cause mortality or myocardial infarction (MI) in patients with ACPneg.We analyzed 1030 consecutive patients admitted with ACPneg in our i…
Cardiac troponin I and T: Exploring popularity with Google Trends
2020
The implementation of high-sensitivity cardiac troponin T (hs-cTnT) assays and a cutoff based on the 99th cTnT percentile in the evaluation of patients with suspected acute coronary syndrome has not been uniform due to uncertain effects on health benefits and utilization of limited resources.Clinical and laboratory data from patients with chest pain or dyspnea at the emergency de¬partment (ED) were evaluated before (n = 20516) and after (n = 18485) the lowering of the hs-cTnT cutoff point from 40 ng/L to the 99th hs-cTnT percentile of 14 ng/L in February 2012. Myocardial infarction (MI) was diagnosed at the discretion of the attending clinicians responsible for the patient.Following lowerin…
A practical approach with outcome for the prognostic assessment of non-ST-segment elevation chest pain and normal troponin.
2007
Patients with non-ST-elevation chest pain constitute a heterogeneous population. Our aim is to compare the outcome of patients with chest pain, non-ST-segment deviation, and normal troponin, categorized using a risk score, with that of patients with ST depression or troponin increase. A total of 1,449 patients with non-ST-elevation chest pain were evaluated. A validated risk score (using pain characteristics and risk factors) was applied to patients without ST depression or troponin increase. Accordingly, 4 risk categories were defined: group 1, no troponin increase, no ST depression, and risk score3 points (n = 633); group 2, no troponin increase, no ST depression, but risk scoreor = 3 poi…
First hospital contact via the Emergency Department is an independent predictor of overall survival and disease-free survival in patients with colore…
2019
espanolObjeto: el objetivo del presente estudio es examinar la asociacion entre el tipo de admision hospitalaria, la supervivencia y las caracteristicas patologicas de una amplia poblacion de pacientes con cancer colorrectal. Metodos: realizamos un estudio en 1.079 pacientes diagnosticados en el Hospital Costa del Sol de Marbella con cancer colorrectal y evaluamos la relacion entre su tasa de supervivencia y la via por la que realizaron el primer contacto con el hospital (admision programada o de urgencias). Las variables incluidas en nuestro estudio fueron las siguientes: edad, genero, localizacion del tumor, estadio patologico, grado de diferenciacion, quimioterapia previa a la cirugia y …
Do Reduced Hospital Mortality Rates Lead to Increased Utilization of Inpatient Emergency Care?:A Population-Based Cohort Study
2018
OBJECTIVES: To measure the impact of the improvement in hospital survival rates on patients' subsequent utilization of unplanned (emergency) admissions.DATA SOURCES/STUDY SETTING: Unplanned admissions occurring in all acute hospitals of the National Health Service in England between 2000 and 2009, including 286,027 hip fractures, 375,880 AMI, 387,761 strokes, and 9,966,246 any cause admissions.STUDY DESIGN: Population-based retrospective cohort study. Unplanned admissions experienced by patients within 28 days, 1 year, and 2 years of discharge from the index admission are modeled as a function of hospital risk-adjusted survival rates using patient-level probit and negative binomial models. …