Paramedic Diagnostic Accuracy for Patients Complaining of Chest Pain or Shortness of Breath

1995 ◽  
Vol 10 (4) ◽  
pp. 245-250 ◽  
Author(s):  
Jeffrey J. Schaider ◽  
John C. Riccio ◽  
Robert J. Rydman ◽  
Peter T. Pons
Keyword(s):  
Chest Pain ◽  
Standard Form ◽  
Kappa Statistic ◽  
Cross Sectional Study ◽  
Organ System ◽  
Shortness Of Breath ◽  
Cross Sectional ◽  
Organ Systems ◽  
Kappa Value ◽  
Chi Square Analysis

AbstractIntroduction:A multitude of life-threatening and nonlife-threatening processes cause chest pain and shortness of breath. Prehospital therapy for these patients may be lifesaving and includes pharmacologic interventions, as well as invasive procedures. Appropriate therapy depends on the diagnostic skills of the paramedic.Objective:This study was undertaken to determine the accuracy of the paramedic diagnosis in patients transported with a chief complaint of pain or shortness of breath.Setting:Multihospital, one large municipal hospital, one community hospital.Design:Prospective, cross-sectional study. Paramedics evaluated the patient and then completed a standard form indicating the diagnosis. The paramedic's and final emergency physician's diagnoses were compared to assess the accuracy of the paramedic diagnosis.Population:All patients who complained of chest pain or shortness of breath, transported to the study centers by the city of Denver paramedia, were eligible for the study. Ninety-nine of the 102 patients enrolled had complete records for analysis and were entered into the study.Results:Diagnostic concordance data were analyzed by organ system (e.g., cardiac, pulmonary, etc.) and for specific diagnoses using the kappa statistic and McNemar's chi-square analysis for discordant pairs. Using the kappa statistic, there was statistically significant concordance between the paramedic and emergency-physician diagnosis for cardiac (p = 0.0001; kappa value = 0.54) and pulmonary organ systems (p = 0.0001; kappa value = 0.61). Overall, for organ system diagnosis, the paramedics had an 82% accuracy (p = 0.05) rating. For specific cardiac and pulmonary diagnosis, paramedics had good concordance with emergency physicians.Conclusions:Overall, paramedia have excellent diagnosis by organ system. They retained good agreement on specific cardiac diagnoses and pulmonary diagnosis.

scholarly journals THE CORRELATION OF SYMPTOMS AND OBJECTIVE WHEEZE IN ASTHMATICS

2020 ◽  
Vol 70 (6) ◽  
pp. 1843-46
Author(s):  
Abdul Latif Khattak ◽  
Muhammad Khalid Azam Khan ◽  
Shazia Naz ◽  
Nauman Kashif ◽  
Syed Karamat Hussain Shah ◽  
...  
Keyword(s):  
Chest Pain ◽  
Study Design ◽  
Clinical Examination ◽  
Cross Sectional Study ◽  
Military Hospital ◽  
Shortness Of Breath ◽  
Sectional Study ◽  
Cross Sectional ◽  
Medicine Department ◽  
Lung Functions

Objective: To determine the correlation between symptoms and objective wheeze in asthmatics. Study Design: A cross sectional study. Place and Duration of Study: Medicine department, Combined Military Hospital Lahore, from Jul to Dec 2019. Methodology: Two hundred patients of asthma were selected reporting in Medicine department, CMH Lahore.Patients were interviewed regarding their primary chest symptom and it was correlated with the clinical examination for wheeze to find which particular symptom correlated most with the presence of wheeze. The 130 symptomatic cases were subjected to spirometry to assess their lung functions tests. Results: Two hundreds patients of asthma were interviewed of whom 130 patients were symptomatic. Out of 130 patients, 59 (45.3%) complained of difficulty in breathing, 40 (30.7%) complained of shortness of breath, 20 (15.3%) had wheezing, 7 (5.3%) had cough and 4 (3%) had chest pain. Eighty five (65.3%) patients when examined had wheeze. The distribution of objective wheezing in the above cases were 100% for wheezing patient, 66.1% for Difficulty in breathing, 57.5% for shortness of breath 28.5% for cough and 25% for chest pain. The FEV1/FVC ratio was lowest for wheezing patients at 0.55 and highest for cough at 0.70. Conclusion: Difficulty in breathing was the commonest symptom in symptomatic asthmatics being presentin 66.1% of patients. The symptom which correlated best with the presence of wheeze was wheezy chest anddifficulty in breathing and was also associated with lowest FEV1/FVC ratio.

scholarly journals Frequency of Injury and Illness in the Final 4 Weeks before a Trail Running Competition

2021 ◽  
Vol 18 (10) ◽  
pp. 5431
Author(s):  
Rubén Gajardo-Burgos ◽  
Manuel Monrroy-Uarac ◽  
René Mauricio Barría-Pailaquilén ◽  
Yessenia Norambuena-Noches ◽  
Dina Christa Janse van Rensburg ◽  
...  
Keyword(s):  
Injury Severity ◽  
Cross Sectional Study ◽  
Organ System ◽  
Cross Sectional ◽  
Anatomical Region ◽  
Gradual Onset ◽  
Organ Systems ◽  
Significant Difference ◽  
Study Participants ◽  
Trail Running

We aimed to (i) determine self-reported injury and illness frequency in trail runners 4 weeks preceding competition; (ii) compare athletes with and without injury/illness by sex, age, body mass index (BMI) and competition distance; (iii) describe mechanism of injury, anatomical region (injury)/organ system (illness) involved, consequences of injury on preparation and self-perception of injury severity; (iv) compare anatomical region (injury) and organ system (illness) by sex. A total of 654 trail runners (age 36.2, IQR 30.6–43.0; 36.9% females) participated in this retrospective cross-sectional study by completing a self-reported questionnaire. Injury and illness frequency rates were 31.3% (n = 205, CI:27.7–35.0%) and 22.3% (n = 146, CI:19.1–25.7%), respectively. No significant difference was found between injured vs. non-injured or ill vs. non-ill study participants by sex, age, BMI and competition distance. Regarding injuries, gradual onset (41.6%) and knee (33.2%) were the most indicated mechanism and anatomical region of injury. At least 85.4% of trail runners changed their training following injury and 79% indicated that their injury would affect their competition performance. Regarding illness, the respiratory tract was the most frequent organ system involved (82.9%). Male and female participants reported similar proportions of anatomical regions (injury) and organ systems (illness) affected. These results could help to generate education strategies and appropriate medical support before and during these competitions.

scholarly journals Evaluation of the disease outcome in Covid-19 infected patients by disease symptoms: a retrospective cross-sectional study in Ilam Province, Iran

2020 ◽  
Author(s):  
Jamil Sadeghifar ◽  
Habib Jalilian ◽  
Khalil Momeni ◽  
Hamed Delam ◽  
Tadesse Sheleme ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Chest Pain ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Study Data ◽  
Shortness Of Breath ◽  
Chi Square ◽  
Cross Sectional ◽  
Radiographic Findings ◽  
Disease Symptoms

AbstractBackgroundnovel coronavirus disease-19 (COVID-19) announced as a global pandemic in the year 2020. With the spread of the disease, a better understanding of patient outcomes associated with their symptoms in diverse geographic levels is vital. We aimed to analysis clinical outcomes of COVID-19 patients by disease symptoms in Ilam province of Iran.MethodsThis is a retrospective study. Data were collected from integrated health system records for all hospitals affiliated to Ilam University of Medical Sciences between 26 Jan 2020 and 02 May 2020. All patients with definite positive test were enrolled in this study. We used descriptive analyses, chi-square test and binary logistic regression to analyze the data using SPSS version 22.ResultsThe mean age was 46.47±18.24 years. Of 3608 patients, 3477 (96.1%) were discharged and 129 (3.9%) were died. 54.2% of the patients were male and were in the age group of 30-40 years old age. Cough, sore throat, shortness of breath or difficulty breathing and fever or chills were the most common symptoms. People with symptoms of shortness of breath, abnormal radiographic findings of the chest, and chest pain and pressure were relatively more likely to die. Based on the findings of binary logistic regression probability of death in people who showed shortness of breath, abnormal chest radiographic findings and chest pain was 1.34, 1.24 and 1.32 times higher than those who did not show these symptoms, respectively.ConclusionOur study provides evidence that presentation of some symptoms does significantly impact on outcomes of patients infected with SARS-CoV-2. Early detection of symptoms and proper management of outcomes can reduce mortality in patients with COVID-19.

scholarly journals Outcome evaluation of COVID-19 infected patients by disease symptoms: a cross-sectional study in Ilam Province, Iran

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jamil Sadeghifar ◽  
Habib Jalilian ◽  
Khalil Momeni ◽  
Hamed Delam ◽  
Tadesse Sheleme ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Chest Pain ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Outcome Evaluation ◽  
Shortness Of Breath ◽  
Sectional Study ◽  
Cross Sectional ◽  
Radiographic Findings ◽  
Disease Symptoms

Abstract Background Novel coronavirus disease-19 (COVID-19) was declared as a global pandemic in 2020. With the spread of the disease, a better understanding of patient outcomes associated with their symptoms in diverse geographic levels is vital. This study aimed to evaluate clinical outcomes of COVID-19 patients by disease symptoms in Ilam province, Iran. Methods This was a cross-sectional study. Data were collected from integrated health system records for all hospitals affiliated with the Ilam University of Medical Sciences between 26-Jan-2020 and 02-May-2020. All patients with a confirmed positive test were included in this study. Descriptive analyses, chi-square test, and binary logistic regression model were performed by using SPSS version 22. Results The mean age of participants was 46.47 ± 18.24 years. Of the 3608 patients, 3477 (96.1%) were discharged, and 129 (3.9%) died. 54.2% of the patients were male and were in the age group of 30–40 years. Cough, sore throat, shortness of breath or difficulty breathing, and fever or chills were the most common symptoms. Patients with symptoms of shortness of breath, abnormal radiographic findings of the chest, and chest pain and pressure were relatively more likely to die. According to binary logistic regression results, the probability of death in patients with shortness of breath, abnormal chest radiographic findings, and chest pain was 1.34, 1.24, and 1.32 times higher, respectively, than for those without. Conclusion Our study provides evidence that the presentation of some symptoms significantly impacts outcomes of patients infected with SARS-CoV-2. Early detection of symptoms and proper management of outcomes can reduce mortality in patients with COVID-19.

Prevalence of COVID-19-like Symptoms among People Living with HIV, and Using Antiretroviral Therapy for Prevention and Treatment

2020 ◽  
Vol 18 (5) ◽  
pp. 373-380 ◽  
Author(s):  
SeyedAhmad SeyedAlinaghi ◽  
Maryam Ghadimi ◽  
Mahboubeh Hajiabdolbaghi ◽  
Mehrnaz Rasoolinejad ◽  
Ladan Abbasian ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Antiretroviral Treatment ◽  
Clinical Symptoms ◽  
Cross Sectional Study ◽  
People Living With Hiv ◽  
Shortness Of Breath ◽  
Sectional Study ◽  
Limited Data ◽  
Cross Sectional ◽  
Living With Hiv

Background: COVID-19 has spread globally with remarkable speed, and currently, there is limited data available exploring any aspect of the intersection between HIV and SARSCoV- 2 co-infection. Objective: To estimate the prevalence of clinical symptoms associated with COVID-19 among people living with HIV (PLWH) in Tehran, Iran. Design: Cross-sectional study. Methods: A total of 200 PLWH were recruited through the positive club via sampling, and completed the symptom-based questionnaire for COVID-19, which was delivered by trained peers. Results: Of 200 participants, respiratory symptoms, including cough, sputum, and shortness of breath, were the most prevalent among participants, but only one person developed symptoms collectively suggested COVID-19 and sought treatments. Conclusions: It appears that existing infection with HIV or receiving antiretroviral treatment (ART) might reduce the susceptibility to the infection with SARS-CoV-2 or decrease the severity of the infection acquired. Further research is needed to understand causal mechanisms.

scholarly journals Comparing Patient and Endoscopist Perceptions of the Colonoscopy Indication

2010 ◽  
Vol 24 (11) ◽  
pp. 656-660 ◽  
Author(s):  
Maida J Sewitch ◽  
Dara Stein ◽  
Lawrence Joseph ◽  
Alain Bitton ◽  
Robert J Hilsden ◽  
...  
Keyword(s):  
Kappa Statistic ◽  
Cross Sectional Study ◽  
Routine Screening ◽  
Self Report ◽  
Administrative Databases ◽  
Screening Colonoscopy ◽  
Cross Sectional ◽  
Simple Method ◽  
Patient Questionnaires

BACKGROUND: Determining whether a colonoscopy is performed for screening or nonscreening purposes can facilitate clinical practice and research. However, there is no simple method to determine the colonoscopy indication using patient medical files or health administrative databases.OBJECTIVE: To determine patient-endoscopist agreement on the colonoscopy indication.METHODS: A cross-sectional study was conducted among staff endoscopists and their patients at seven university-affiliated hospitals in Montreal, Quebec. The study participants were 50 to 75 years of age, they were able to understand English or French, and were about to undergo colonoscopy. Self- (endoscopist) and interviewer-administered (patient) questionnaires ascertained information that permitted classification of the colonoscopy indication. Patient colonoscopy indication was defined as the following: perceived screening (routine screening, family history, age); perceived nonscreening (follow-up); medical history that implied nonscreening; and a combination of the three preceding indications. Agreement between patient and endoscopist indications was measured using concordance and Kappa statistic.RESULTS: In total, 702 patients and 38 endoscopists participated. The three most common reasons for undergoing colonoscopy were routine screening/regular check-up (33.8%), follow-up to a previous problem (30.2%) and other problem (24.6%). Concordance (range 0.79 to 0.85) and Kappa (range 0.58 to 0.70) were highest for perceived nonscreening colonoscopy. Recent large bowel symptoms accounted for 120 occurrences of disagreement in which the patient perceived a nonscreening colonoscopy while the endoscopist perceived a screening colonoscopy.CONCLUSIONS: Patient self-report may be an acceptable means for rapidly assessing whether a colonoscopy is performed for screening or nonscreening purposes. Delivery of patient-centred care may help patients and endoscopists reach a shared understanding of the reason for colonoscopy.

scholarly journals Impact of the Neuregulin rs35753505 C/T Polymorphisms on Neuregulin 1 Levels in Preterm Infants

2019 ◽  
Vol 7 (12) ◽  
pp. 1931-1934
Author(s):  
Bugis Mardina Lubis ◽  
Sjarif Hidajat Effendi ◽  
Ratna Akbari Ganie ◽  
Oke Rina Ramayani
Keyword(s):  
Preterm Infants ◽  
Cross Sectional Study ◽  
Enzyme Linked Immunosorbent Assay ◽  
P Value ◽  
Nucleotide Polymorphisms ◽  
Gene Encoding ◽  
Cross Sectional ◽  
Neuregulin 1 ◽  
Organ Systems ◽  
The Impact

BACKGROUND: Neuregulin (NRG) 1 plays an important role in the development of various organ systems in human. Single nucleotide polymorphisms rs35753505 C/Tof the gene encoding NRG1 evident as allele C and T with genotypes of CT, CC, and TT are believed to have an impact on NRG1 levels.AIM: To determine the impact of the NRGrs35753505 C/T polymorphisms on NRG1 levels in preterm infants.METHODS: A cross-sectional study was conducted from February to December 2018, whereas 48 eligible preterm infants with a gestational age of 32- < 37 weeks were enrolled. An umbilical cord blood specimen was collected for determination of NRG1 levels with enzyme-linked immunosorbent assay (ELISA) and NRG1 polymorphisms with polymerase chain reaction (PCR). Statistical analysis was performed with 95%CI and P value of < 0.05 was considered statistically significant.RESULTS: Median value of NRG1 levels (174.4 pg/ml) served as a cut off value. NRG 1 polymorphisms composed distribution of CC (31%), CT (42%), TT (27%) genotypes and distribution of C and T alleles were 52% and 48%. The median NRG1 levels in CC and CT genotypes were significantly lower compared to TT genotype (151.1 pg/ml vs 407.2 pg/ml, P = 0.005 and 159.1 pg/ml vs 407.2 pg/ml, P = 0.009). Subjects with C allele had significantly lower median NRG1 levels than T allele (151.1 pg/ml vs 407.2 pg/ml, P = 0.002). Subjects with CC and CT genotypes had higher risk to develop lower NRG1 levels compared to TT genotype (OR = 8.25, P = 0.016 and OR = 10.74, P = 0.005, respectively).CONCLUSION: Allele C is associated with lower NRG1 levels. Preterm infants with CC and CT genotypes pose a higher risk to have lower NRG1 levels.

scholarly journals Health Canada’s use of expedited review pathways and therapeutic innovation, 1995–2016: cross-sectional analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e023605 ◽  
Author(s):  
Joel Lexchin
Keyword(s):  
Anatomical Therapeutic Chemical ◽  
Cross Sectional Study ◽  
New Drugs ◽  
Cross Sectional ◽  
Time Period ◽  
Therapeutic Value ◽  
Kappa Value ◽  
Innovative Drugs ◽  
Sectional Analysis ◽  
Health Canada

ObjectivesThis study examines the use of expedited approval pathways by Health Canada over the period 1995 to 2016 inclusive and the relationship between the use of these pathways and the therapeutic gain offered by new products.DesignCross-sectional study.Data sourcesTherapeutic Products Directorate, Biologics and Genetic Therapies Directorate, Notice of Compliance database, Notice of Compliance with conditions web site, Patented Medicine Prices Review Board, La revue Prescrire, WHO Anatomical Therapeutic Chemical classification system.Primary and secondary outcomesPercent of new drugs evaluated by Health Canada that went through an expedited pathway between 1995 and 2016 inclusive. Kappa values comparing the review status with assessments of therapeutic value for individual drugs.ResultsOf 623 drugs approved by Health Canada between 1995 and 2016, 438 (70.3%) drugs went through the standard pathway and 185 (29.7%) an expedited pathway. Therapeutic evaluations were available for 509 drugs. Health Canada used an expedited approval pathway for 159 of the 509 drugs, whereas only 55 were judged to be therapeutically innovative. Forty-two of the 55 therapeutically innovative drugs received an expedited review and 13 received a standard review. The Kappa value for the entire period for all 509 drugs was 0.276 (95% CI 0.194 to 0.359) indicating ‘fair’ agreement between Health Canada’s use of expedited pathways and independent evaluations of therapeutic innovation.ConclusionHealth Canada’s use of expedited approvals was stable over the entire time period. It was unable to reliably predict which drugs will offer major therapeutic gains. The findings in this study should provoke a discussion about whether Health Canada should continue to use these pathways and if so how their use can be improved.

Increased Incidence of Injury Among Runners With COVID-19

2021 ◽  
pp. 194173812110611
Author(s):  
Brett G. Toresdahl ◽  
James N. Robinson ◽  
Stephanie A. Kliethermes ◽  
Jordan D. Metzl ◽  
Sameer Dixit ◽  
...  
Keyword(s):  
New York ◽  
Cross Sectional Study ◽  
Multiple Organ ◽  
Medical Professional ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Direct Role ◽  
Cross Sectional ◽  
Electronic Survey ◽  
Organ Systems

Background: Coronavirus disease 2019 (COVID-19) affects multiple organ systems. Whether and how COVID-19 affects the musculoskeletal system remains unknown. We aim to assess the association between COVID-19 and risk of injury. Hypothesis: Runners who report having COVID-19 also report a higher incidence of injury. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: An electronic survey was distributed from July through September 2020, by New York Road Runners, ASICS North America, race medical directors, and through social media. Inclusion criteria were runners 18 years or older who had participated in ≥1 race (running or triathlon) in 2019. Results: A total of 1947 runners participated and met inclusion criteria. Average age was 45.0 (SD, 12.2) years and 56.5% were women. A total of 123 (6.3%) runners self-reported having COVID-19; 100 (81%) reported their diagnosis was from a laboratory test (polymerase chain reaction or antibody) and 23 reported being diagnosed by a medical professional without confirmatory laboratory testing. Since March 2020, 427 (21.9%) reported an injury that prevented running for at least 1 week, including 38 of 123 (30.9%) who self-reported having COVID-19 and 389 of 1435 (21.3%) who did not report having COVID-19 ( P = 0.01). After adjusting for age, sex, the number of races in 2019, and running patterns before March 2020, runners who self-reported a diagnosis of COVID-19 had a higher incidence of injury compared with those who did not (odds ratio, 1.66; 95% CI, 1.11-2.48; P = 0.01). Conclusion: Injuries were more often self-reported by runners with laboratory-confirmed or clinically diagnosed COVID-19 compared with those who did not report COVID-19. Given the limitations of the study, any direct role of COVID-19 in the pathophysiology of injuries among runners remains unclear. Clinical Relevance: Direct and indirect musculoskeletal sequelae of COVID-19 should be further investigated, including the risk of exercise- and sports-related injury after COVID-19.

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