scholarly journals MP46: Creatine kinase in the emergency department: antiquated relic or useful adjunct in diagnosis of NSTEMI: A systematic review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S59
Author(s):  
D. Beamish ◽  
T. Maniuk ◽  
M. Mukarram ◽  
V. Thiruganasambandamoorthy
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Creatine Kinase ◽  
Final Analysis ◽  
Outcome Data ◽  
Definitive Diagnosis ◽  
Cardiac Biomarkers ◽  
Reference List ◽  
Published Evidence ◽  
Work Up

Introduction: The diagnosis of non-ST elevated myocardial infarction (NSTEMI) depends on a combination of history, ECG and cardiac biomarkers. Many hospitals continue to automatically order less sensitive and specific biomarkers such as Creatine Kinase (CK) alongside cardiac Troponin (cTn) as part of an extended panel of bloodwork for work-up of patients with suspected NSTEMI. Methods: We undertook a systematic review to assess the usefulness of CK measurements in addition to cTnI in NSTEMI diagnosis. Medline, EMBASE and Cochrane databases were searched from 1995 until May 31, 2018. We added additional articles after reviewing the reference list of pertinent articles and consulting experts. A total of 1123 papers were screened, of which 8 were included in the final analysis. These papers all compared CK and troponin (TnI) testing in the diagnosis of NSTEMI. Results: Of the 8 papers included in the analysis none showed CK having a greater sensitivity or specificity than the TnI assays. Furthermore, no paper originally published evidence of CK diagnosing NSTEMI when Troponin was negative. One author, when contacted, described 10% of patients diagnosed with NSTEMI as having discordant data (eg. +CK, -Troponin). However, the outcome data such as angiography and echocardiography were not available for these patients, making definitive diagnosis unclear. Conclusion: Troponin has consistently shown to have greater sensitivity and specificity than CK in the diagnosis of NSTEMI with CK adding no improvements in diagnosis. We believe CK should not be used in the emergency department work-up for NSTEMI diagnosis.

scholarly journals Role of Creatine Kinase in the Troponin Era: A Systematic Review

2021 ◽  
Vol 22 (6) ◽  
pp. 1291-1294
Author(s):  
Daniel Beamish ◽  
Tetyana Maniuk ◽  
Muhammad Mukarram ◽  
Venkatesh Thiruganasambandamoorthy
Keyword(s):  
Systematic Review ◽  
Creatine Kinase ◽  
Chest Pain ◽  
Cardiac Injury ◽  
Final Analysis ◽  
Cardiac Biomarkers ◽  
Coronary Syndrome ◽  
Pain Patients ◽  
Negative Conclusion

Introduction: The diagnosis of non-ST-elevated myocardial infarction (NSTEMI) depends on a combination of history, electrocardiogram, and cardiac biomarkers. The most sensitive and specific biomarkers for cardiac injury are the troponin assays. Many hospitals continue to automatically order less sensitive and less specific biomarkers such as creatine kinase (CK) alongside cardiac troponin (cTn) for workup of patients with chest pain. The objective of this systematic review was to identify whether CK testing is useful in the workup of patients with NSTEMI symptoms. Methods: We undertook a systematic review to ascertain whether CK ordered as part of the workup for NSTEMI was useful in screening patients with cardiac chest pain. The MEDLINE, Embase, and Cochrane databases were searched from January 1995–September 2020. Additional papers were added after consultation with experts. We screened a total of 2,865 papers, of which eight were included in the final analysis. These papers all compared CK and cTn for NSTEMI diagnosis. Results: In each of the eight papers included in the analysis, cTn showed a greater sensitivity and specificity than CK in the diagnosis of NSTEMI. Furthermore, none of the articles published reliable evidence that CK is useful in NSTEMI diagnosis when troponin was negative. Conclusion: There is no evidence to continue to use CK as part of the workup of NSTEMI acute coronary syndrome in undifferentiated chest pain patients. We conclude that CK should not be used to screen patients presenting to the emergency department with chest pain.

Effective Factors in Improving the Emergency Department Preparedness of Hospitals in Radiation and Nuclear Incidents and Nuclear Terrorism: A Systematic Review

2020 ◽  
Author(s):  
Milad AHMADI MARZALEH ◽  
Rita REZAEE ◽  
Abbas REZAIANZADEH ◽  
Mahnaz RAKHSHAN ◽  
Gholamhassan HADDADI ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Nuclear Power ◽  
Final Analysis ◽  
Systematic Search ◽  
Cochrane Library ◽  
Effective Factors ◽  
Nuclear Terrorism ◽  
The World ◽  
Collection Form

Background: Due to existence of nuclear power plant sites in various parts of the world, as well as political threats in disaster-prone areas throughout the world, there is a probability of nuclear and radiation incidents. The present study aimed to extract effective criteria in emergency department preparedness of hospitals in radiation, nuclear incidents and nuclear terrorism in different countries around the world. Methods: A systematic search was carried out in Cochrane Library, PubMed, Scopus, Science Direct, Web of Science, ProQuest and Embase databases between Jan 1970 and Jul 2018. The systematic search was carried out according to the PRISMA standard. The required information was extracted from the papers based on the abstract and collection form. Results: Overall, 1091 papers were finally extracted. The initial search included research papers. After reviewing the papers’ titles, abstracts and full texts, 15 papers were selected for final analysis. Next, 32 criteria were extracted. The criteria were divided into 3 categories. The categories included staff, stuff and systems (structure). The most frequent criteria included training criteria, personal protective equipment, decontamination and practice. Conclusion: The results of the systematic review provided an overview of the effective factors in improving the emergency department preparedness during radiation and nuclear incidents. In addition to the mentioned criteria in different studies, other hidden factors affect the emergency department preparedness in radiation and nuclear incidents. Thus, the highest level of preparedness should be considered.

scholarly journals Indirect Impact of the COVID-19 Pandemic on Hospitalisations For Cardiometabolic Conditions and Their Management: A Systematic Review

2021 ◽  
Author(s):  
SAMUEL SEIDU ◽  
Kunutsor SK ◽  
Xavier Cos ◽  
K. Khunti
Keyword(s):  
Systematic Review ◽  
Health Care Systems ◽  
Clinical Care ◽  
Length Of Hospital Stay ◽  
Reference List ◽  
Coronary Syndrome ◽  
Published Evidence ◽  
Hospitalised Patients ◽  
Indirect Impact ◽  
Care Systems

Abstract Background: The Coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic crisis in health care systems worldwide. These may have significant implications for the management of cardiometabolic diseases. We conducted a systematic review of published evidence to assess the indirect impact of the COVID-19 pandemic on hospitalisations for cardiovascular diseases and their management.Methods: Studies that evaluated volume of hospitalisations for cardiometabolic conditions and their management with comparisons between the COVID-19 and pre-COVID periods were identified from MEDLINE, Embase and the reference list of relevant studies from January 2020 to 25 February 2021. Results: We identified 103 observational studies, with most studies assessing hospitalisations for acute cardiovascular conditions such as acute coronary syndrome, ischemic strokes and heart failure. About 89% of studies reported a decline in hospitalisations during the pandemic compared to pre-pandemic times, with reductions ranging from 20.2 to 73%. Severe presentation, less utilization of cardiovascular procedures, and longer patient- and healthcare-related delays were common during the pandemic. Most studies reported shorter length of hospital stay during the pandemic than before the pandemic (1-8 vs 2-12 days) or no difference in length of stay. Most studies reported no change in in-hospital mortality among hospitalised patients.Conclusion: Routine and ongoing clinical care of patients for acute cardiovascular conditions, their management and outcomes have been adversely impacted by the COVID-19 pandemic. Patients should be educated via population-wide approaches on the need for timely medical contact and health systems should put strategies in place to provide timely care to patients at high risk.

Characteristics of the Frequency-Following Response to Speech in Neonates and Potential Applicability in Clinical Practice: A Systematic Review

2020 ◽  
Vol 63 (5) ◽  
pp. 1618-1635
Author(s):  
Céline Richard ◽  
Mary Lauren Neel ◽  
Arnaud Jeanvoine ◽  
Sharon Mc Connell ◽  
Alison Gehred ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cochrane Library ◽  
Neurodevelopmental Outcomes ◽  
Frequency Following Response ◽  
Ovid Medline ◽  
Published Evidence ◽  
Mesh Terms ◽  
Potential Applicability ◽  
Clinical Potential

Purpose We sought to critically analyze and evaluate published evidence regarding feasibility and clinical potential for predicting neurodevelopmental outcomes of the frequency-following responses (FFRs) to speech recordings in neonates (birth to 28 days). Method A systematic search of MeSH terms in the Cumulative Index to Nursing and Allied HealthLiterature, Embase, Google Scholar, Ovid Medline (R) and E-Pub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Web of Science, SCOPUS, COCHRANE Library, and ClinicalTrials.gov was performed. Manual review of all items identified in the search was performed by two independent reviewers. Articles were evaluated based on the level of methodological quality and evidence according to the RTI item bank. Results Seven articles met inclusion criteria. None of the included studies reported neurodevelopmental outcomes past 3 months of age. Quality of the evidence ranged from moderate to high. Protocol variations were frequent. Conclusions Based on this systematic review, the FFR to speech can capture both temporal and spectral acoustic features in neonates. It can accurately be recorded in a fast and easy manner at the infant's bedside. However, at this time, further studies are needed to identify and validate which FFR features could be incorporated as an addition to standard evaluation of infant sound processing evaluation in subcortico-cortical networks. This review identifies the need for further research focused on identifying specific features of the neonatal FFRs, those with predictive value for early childhood outcomes to help guide targeted early speech and hearing interventions.

Elderly patientsʼ experiences of care in the emergency department: a systematic review

2010 ◽  
Vol 8 (Supplement) ◽  
pp. 1-25
Author(s):  
Lim Siew Hoon ◽  
Sandra Mackey ◽  
He Hong-Gu
Keyword(s):  
Systematic Review ◽  
Emergency Department

scholarly journals AB0073 INTESTINAL PERMEABILITY IN SPONDYLOARTHRITIS: A SYSTEMATIC REVIEW OF THE LITERATURE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1067.1-1067
Author(s):  
S. Hecquet ◽  
P. Totoson ◽  
H. Martin ◽  
C. Prati ◽  
D. Wendling ◽  
...  
Keyword(s):  
Systematic Review ◽  
Disease Activity ◽  
Intestinal Permeability ◽  
Intestinal Inflammation ◽  
Intestinal Barrier ◽  
Basic Research ◽  
Final Analysis ◽  
Potential Marker ◽  
Inflammatory Drugs ◽  
Permeability Evaluation

Background:Growing evidence argue for a role of the gut in the pathophysiology of various chronic rheumatic diseases such as spondyloarthritis (SpA). This so-called “gut-joint axis” involves dysbiosis, bacterial translocation, intestinal inflammation and increase in intestinal permeability. Recent data from clinical and basic research suggested that the integrity of the intestinal barrier might be a key determinant in translating autoimmunity to inflammation, making intestinal permeability a potential marker or a target for future therapies.Objectives:To analyse the available data on intestinal permeability in SpA patients and the effects of drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) on intestinal permeability.Methods:A systematic review was conducted. Without date restriction, the following databases were searched through September 1, 2020: Medline, Embase and Cochrane. Studies with patients with SpA assessing the intestinal permeability were selected. Some of the included studies have assessed the effect of NSAIDs on intestinal permeability.Results:A total of 12 studies were included in the final analysis. The 12 studies involved a total of 268 SpA patients, including 240 ankylosing spondylitis (AS). Among the studies included, four studies used the lactulose/mannitol test, four studies used the 51Cr-ethylenediaminetetraacetic test and two studies used the polyethylene glycols test. Nine of the 12 studies reported increased intestinal permeability regardless on the method used for intestinal permeability evaluation. Four studies evaluated the link between disease activity, assessed by CRP and ESR levels, and intestinal permeability and showed no correlation between increased intestinal permeability and markers of disease activity in AS patients. As regards the effects of NSAIDs on intestinal permeability, data are controversial. Two studies, including one evaluating indomethacin, did not show any influence of NSAIDs in AS patients, one study showed an increase in intestinal permeability under NSAIDs in only 60% of the patients, another study reported increased intestinal permeability. When comparing the effect of NSAIDs in patients with AS to healthy subjects, one study reported a comparable NSAIDs-induced increase in intestinal permeability in both groups.Conclusion:The results of our review suggest that increased intestinal permeability is present in SpA patients even in the absence of NSAIDs use and regardless of the method used to assess intestinal permeability. The effects of NSAIDs on intestinal permeability in SpA patients is more controversial and further studies are needed to clarify them.Disclosure of Interests:None declared

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