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Lafleur J, Rutenberg A. An unusual cause of chest pain in a 33 year old male: neurofibromatosis. Am J Emerg Med 2020; 38:1963.e1-1963.e3. [DOI: 10.1016/j.ajem.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022] Open
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Spencer TR, Sidhu MS, Bisaillon J, Christopher King C. Novel Cardiac Biomarkers for Emergency Department Evaluation of Acute Coronary Syndrome: The Recent Evidence on Non-troponin Biomarkers and Their Limitations. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40138-016-0104-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Meek R, Braitberg G, Cullen L, Than M, Graudins A, Glynn D. Outcome at 30 days for low-risk chest pain patients assessed using an accelerated diagnostic pathway in the emergency department. Emerg Med Australas 2016; 28:279-86. [PMID: 26998819 DOI: 10.1111/1742-6723.12570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/07/2016] [Accepted: 02/04/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Primary: to determine incidence of 30 day major adverse cardiac events (MACE) in patients discharged from the ED following assessment using an accelerated diagnostic pathway (ADP). Secondary: to determine incidence of 30 day MACE for all ADP patients. METHODS Monash Health ED patients thought at low risk for acute myocardial infarction (AMI) or hospital admission are assessed using an ADP, based on arrival and 90 min point-of-care (POC) cardiac troponin I and myoglobin concentration. Other patients are assessed using a traditional pathway of arrival and 6 h central lab cardiac troponin I. Choice of pathway is based on the clinical judgement of the attending ED doctor. To investigate the safety of the ADP component, an observational study of all ADP patients presenting from 6 June 2013 to 30 September 2013 was conducted. After 30 days, occurrence of MACE was determined by examination of hospital records or telephone contact with patients who had not returned. RESULTS Of 1547 eligible patients, 1384 (89.5%) were followed up. Of the 1143 discharged patients with follow-up information, 30 day MACE occurred in one (0.09%, 95% CI 0.002-0.5). Of all 1547 patients, 60 patients had a MACE detected: 56 AMI during the initial attendance, four AMI post-discharge (one from ED, three after hospital admission). In total, of the 1328 patients who did not have AMI during the target admission and were followed up, 30 day post-discharge MACE occurred in four patients (0.3%, 95% CI 0.08-0.8). CONCLUSION The ADP supports safe, early discharge of low-risk chest pain patients from the ED.
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Affiliation(s)
- Robert Meek
- Monash Emergency Medicine Program, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - George Braitberg
- Monash Emergency Medicine Program, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Louise Cullen
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
| | - Martin Than
- Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand.,School of Medicine, University of Otago, Christchurch, New Zealand
| | - Andis Graudins
- Monash Emergency Medicine Program, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Deirdre Glynn
- Monash Emergency Medicine Program, Monash Health, Melbourne, Victoria, Australia
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Byrne J. Introducing a chest pain pathway in the emergency department to improve quality of care for patients with possible cardiac chest pain. BMJ QUALITY IMPROVEMENT REPORTS 2014; 3:u204753.w2003. [PMID: 26734306 PMCID: PMC4645935 DOI: 10.1136/bmjquality.u204753.w2003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 04/24/2014] [Indexed: 11/06/2022]
Abstract
Chest pain is a common reason for patients to present to an emergency department (ED). It is crucial not to miss presentations of the potentially life-threatening acute coronary syndrome (ACS), although often these people present with a non-diagnostic ECG. This makes recognition of a history consistent with ACS very important. We noted inconsistencies in assessment, with many admissions to cardiology beds who did not prove to have ACS and some erroneous discharges who subsequently did have an ACS. We introduced a history based risk tool as part of a chest pain pathway into the ED for use by medical staff assessing patients presenting with chest pain. The intervention involved a nurse from cardiology engaging with clerical, nursing, and medical staff in the ED to ensure success of this quality improvement project. The project showed a reduction in admissions to cardiology with suspected ACS from 29% to 15%, with a projected saving of £889 per patient who was prevented from being admitted. In addition, admissions became more appropriate, with an increase in the proportion of patients with a final diagnosis of ACS from 25% to 46% and a reduction in admissions with atypical chest pain from 75% to 54%.
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Souza D, Ledbetter S. Diagnostic errors in the evaluation of nontraumatic aortic emergencies. Semin Ultrasound CT MR 2012; 33:318-36. [PMID: 22824122 DOI: 10.1053/j.sult.2012.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Nontraumatic aortic emergencies (NTAE) are a complex and dynamic group of serious, potentially fatal conditions affecting the aorta. These entities most often present in the emergency department setting, and include aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, as well as aortic rupture and impending rupture. The radiologist plays a critical role in prompt diagnosis and evaluation since presenting signs and symptoms are often nonspecific. This article focuses on the potential sources of error in the imaging evaluation of patients presenting with NTAE.
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Affiliation(s)
- Daniel Souza
- Cancer Imaging, Dana Farber Cancer Institute, Harvard Medical School, and Brigham and Women's Hospital, Boston, MA 02115, USA.
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