scholarly journals Validation of a Decision Rule and Derivation of a Modified Rule to Obtain Chest Radiograph in Patients with Nontraumatic Chest Pain in the Emergency Department

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Case Newsom ◽  
Rebecca Jeanmonod ◽  
Karl Weller ◽  
Nabil Boutros ◽  
Mark Reiter ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Congestive Heart Failure ◽  
Chest Pain ◽  
Alcohol Abuse ◽  
Decision Rule ◽  
Predictive Value ◽  
Breath Sounds ◽  
History Of ◽  
Sensitivity Specificity

Objectives. We sought to validate and refine a decision rule for chest X-ray (CXR) utilization in nontraumatic chest pain (CP) patients presenting to the emergency department (ED). Methods. Retrospective review of ED patients presenting with CP who had CXR performed during three nonconsecutive months was performed. The presence of 18 variables derived from history and exam was ascertained. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the original rule were calculated. Refinement using additional variables was performed. Results. 967 patient charts were reviewed. 89.9% of CXR were normal, 5.2% had insignificant findings, and 5.1% had significant findings. Application of the criteria had a sensitivity/specificity of 74%/59% and a PPV/ NPV of 9%/98%. Rule modification to obtain CXR for age ≥ 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintained sensitivity while improving specificity to 69%. Conclusions. Most CP patients have normal CXRs. Narrowing a decision rule to obtain CXR in patients with age ≥ 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintain sensitivity while improving specificity and NPV.

scholarly journals Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome

CJEM ◽  
2010 ◽  
Vol 12 (02) ◽  
pp. 128-134 ◽  
Author(s):  
Erik P. Hess ◽  
Jeffrey J. Perry ◽  
Pam Ladouceur ◽  
George A. Wells ◽  
Ian G. Stiell
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Congestive Heart Failure ◽  
Chest Pain ◽  
Chest Radiography ◽  
Clinical Decision ◽  
Chest Radiographs ◽  
Clinical Decision Rule ◽  
Coronary Syndrome ◽  
History Of

ABSTRACTObjective:We derived a clinical decision rule to determine which emergency department (ED) patients with chest pain and possible acute coronary syndrome (ACS) require chest radiography.Methods:We prospectively enrolled patients over 24 years of age with a primary complaint of chest pain and possible ACS over a 6-month period. Emergency physicians completed standardized clinical assessments and ordered chest radiographs as appropriate. Two blinded investigators independently classified chest radiographs as “normal,” “abnormal not requiring intervention” and “abnormal requiring intervention,” based on review of the radiology report and the medical record. The primary outcome was abnormality of chest radiographs requiring acute intervention. Analyses included interrater reliability assessment (with κ statistics), univariate analyses and recursive partitioning.Results:We enrolled 529 patients during the study period between Jul. 1, 2007, and Dec. 31, 2007. Patients had a mean age of 59.9 years, 60.3% were male, 4.0% had a history of congestive heart failure and 21.9% had a history of acute myocardial infarction. Only 2.1% (95% confidence interval [CI] 1.1%–3.8%) of patients had radiographic abnormality of the chest requiring acute intervention. The κ statistic for chest radiograph classification was 0.81 (95% CI 0.66–0.95). We derived the following rule: patients can forgo chest radiography if they have no history of congestive heart failure, no history of smoking and no abnormalities on lung auscultation. The rule was 100% sensitive (95% CI 32.0%–10.4%) and 36.1% specific (95% CI 32.0%–40.4%).Conclusion:This rule has potential to reduce health care costs and enhance ED patient flow. It requires validation in an independent patient population before introduction into clinical practice.

scholarly journals Σύγκριση της δοκιμασίας σύνδεσης κοβαλτίου - αλβουμίνης και του υπερηχογραφήματος καρδιάς στην διαγνωστική ασθενών με θωρακικό πόνο

2013 ◽  
Author(s):  
Ευαγγελία Κουντάνα
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Unstable Angina ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Stress Test ◽  
Acute Chest Pain ◽  
Developed Countries ◽  
Coronary Syndrome ◽  
Sensitivity Specificity

Cardiovascular disease is the leading cause of mortality in developed countries andplaces a massive burden on healthcare services. Thousands of patients visit every yearthe Emergency Department (ED) with acute chest pain and a considerable proportionhas an acute coronary syndrome (ACS). In most cases, the electrocardiogram and thecommonly used biomarkers are not helpful in the early diagnosis of myocardialischemia.ObjectiveTo assess the role of ischemia modified albumin (IMA), a novel cardiac biomarker, inexcluding unstable angina (UA) in patients visiting the ED with acute chest pain. Thepredictive value of serum IMA concentrations were evaluated in comparison toechocardiogram.MethodsWe studied 33 patients (84.8% males, age 59.8±10.8 years) who presented at theAccident and Emergency Department with acute chest pain lasting < 3 h, normal ornon-diagnostic electrocardiogram and normal serum troponin and CK-MB levels.Serum IMA levels were determined and a comprehensive echocardiographic studywas performed. All patients were admitted to our Department of Cardiology and thediagnosis of UA was established with exercise or thallium stress test or with coronaryangiography.ResultsFive patients were eventually diagnosed with UA. The area under the curve for thediagnosis of unstable angina based on serum IMA levels was 0.193 (95% confidenceinterval 0.047-0.339, p < 0.05). Serum IMA levels ≥ 31,95 IU/ml had a sensitivity,specificity, positive and negative predictive value for the diagnosis of UA of 40.0%,28.6%, 9.1% and 72.7%, respectively. The sensitivity, specificity, positive andnegative predictive value of echocardiography for the diagnosis of UA was 60.0%,89.3%, 50.0% and 92.6%, respectively.Conclusion: Assessment of serum IMA levels in patients presenting with suspectedUA has comparable negative predictive value with echocardiography for excludingthe diagnosis of UA. Therefore, this biomarker appears to be useful in the diagnosisand stratification of risk in patients with ACS.

scholarly journals UJI DIAGNOSTIK NT pro NATRIURETIC PEPTIDE (NTpro BNP) GAGAL JANTUNG KONGESTIF

2016 ◽  
Vol 18 (1) ◽  
pp. 48
Author(s):  
Dewi Indah Noviana Pratiwi ◽  
Suwarso Suwarso ◽  
Osman Sianipar
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Negative Predictive Value ◽  
Natriuretic Peptide ◽  
Predictive Value ◽  
Clinical Performance ◽  
Operating Characteristics ◽  
Likelihood Ratios ◽  
Roc Curve Analysis ◽  
Sensitivity Specificity

Congestive Heart Failure (CHF) is a syndrome associated with disturbances of heart structure and function, as a result of various cardiovascular diseases. These disturbances decrease ventricle ability to pump or fill blood in physiological pressure, which causes limitation on the ability to excercise or daily activities without dyspnea and fatigue.Early diagnosis is important to initiate prompt treatment that can prevent further disease development. To measure heart hormone in this case, NT pro Natriuretic Peptide (NT pro BNP) can be use as a more ideal examination for early detection of CHF. The aim of this study is to investigate the clinical performance of NT pro BNP and assess the cut-off point 125 pg/mL compared to clinic (Framingham criteria) and or echocardiogram in the diagnosis CHF.The diagnostic test was carried out using clinical (Framingham criteria) and or echocardiography as reference methods. The subject of this research was patients with cardiac and blood vessel disorders complaints at risk of developing congestive heart failure, who came to the Emergency Department at Dr. Sardjito Hospital Yogyakarta, supported by clinical data, radiology, other laboratory test, electrocardiography and echocardiography. The diagnosis of CHF was obtained by conducting investigation toward echocardiography examination reading in patient’s medical record. Receiver Operating Characteristics (ROC) curve analysis was conducted using SPSS 13.0 program. Sensitivity, specificity, positive and negative predictive value, accuracy and likelihood ratios were measured with 2x2 table by CAT marker program. Forty-six of fifty-seven specimens were from congestive heart failure (CHF). At 125 pg/mL as a cut-off point, regardless the interval between the onset of the symptoms and taking of blood samples, the sensitivity, specificity, positive and negative predictive value and diagnostic accuracy are 96%, 36%, 86%, 67%, 84% respectively. Likelihood ratios for positive and negative results are 1.50 and 0.12. NT pro BNP measuring is expected to give more benefit than the conventional signal, so that an early diagnosis can be achieved accurately in a timely manner.

scholarly journals Value of preoperative computed tomography for meso-Rex bypass in children with extrahepatic portal vein obstruction

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Huiying Wu ◽  
Ning Zhou ◽  
Lianwei Lu ◽  
Xiwen Chen ◽  
Tao Liu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Portal Vein ◽  
Predictive Value ◽  
Extrahepatic Portal Vein Obstruction ◽  
Portal Vein Obstruction ◽  
Left Portal Vein ◽  
History Of ◽  
Associated Malformations ◽  
Sensitivity Specificity

Abstract Background Extrahepatic portal vein obstruction (EHPVO) is the most important cause of hematemesis in children. Intrahepatic left portal vein and superior mesenteric vein anastomosis, also known as meso-Rex bypass (MRB), is becoming the gold standard treatment for EHPVO. We analyzed the value of preoperative computed tomography (CT) in determining whether MRB is feasible in children with EHPVO. Results We retrieved data on 76 children with EHPVO (50 male, 26 female; median age, 5.9 years) who underwent MRB (n = 68) or the Warren procedure (n = 8) from 2013 to 2019 and retrospectively analyzed their clinical and CT characteristics. The Rex recess was categorized into four subtypes (types 1–4) depending on its diameter in CT images. Of all 76 children, 7.9% had a history of umbilical catheterization and 1.3% had leukemia. Sixteen patients (20 lesions) had associated malformations. A total of 72.4% of Rex recesses could be measured by CT, and their mean diameter was 3.5 ± 1.8 mm (range 0.6–10.5 mm). A type 1, 2, 3, and 4 Rex recess was present in 9.2%, 53.9%, 11.8%, and 25.0% of patients, respectively. MRB could be performed in patients with types 1, 2, and 3, but those with type 4 required further evaluation. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of CT were 100%, 83.8%, 42.1%, 100%, and 85.5%, respectively. Conclusions Among the four types of Rex recesses on CT angiography, types 1–3 allow for the performance of MRB.

scholarly journals Age-Related Frailty: A Clinical Model for Geroscience?

2020 ◽  
Vol 24 (10) ◽  
pp. 1140-1143 ◽  
Author(s):  
Catherine Takeda ◽  
D. Angioni ◽  
E. Setphan ◽  
T. Macaron ◽  
P. De Souto Barreto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Medical History ◽  
Older Age ◽  
The Other ◽  
Everyday Practice ◽  
Clinical Model ◽  
Main Contributor ◽  
Age Related ◽  
History Of

AbstractIn their everyday practice, geriatricians are confronted with the fact that older age and multimorbidity are associated to frailty. Indeed, if we take the example of a very old person with no diseases that progressively becomes frail with no other explanation, there is a natural temptation to link frailty to aging. On the other hand, when an old person with a medical history of diabetes, arthritis and congestive heart failure becomes frail there appears an obvious relationship between frailty and comorbidity. The unsolved question is: Considering that frailty is multifactorial and in the majority of cases comorbidity and aging are acting synergistically, can we disentangle the main contributor to the origin of frailty: disease or aging? We believe that it is important to be able to differentiate age-related frailty from frailty related to comorbidity. In fact, with the emergence of geroscience, the physiopathology, diagnosis, prognosis and treatment will probably have to be different in the future.

scholarly journals Effects of Dust Storms and Climatological Factors on Mortality and Morbidity of Cardiovascular Diseases Admitted to ED

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Behcet Al ◽  
Mustafa Bogan ◽  
Suat Zengin ◽  
Mustafa Sabak ◽  
Seval Kul ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Chest Pain ◽  
Cardiovascular Diseases ◽  
Dust Storm ◽  
Dust Storms ◽  
Maximum Temperature ◽  
Inpatient Hospitalization ◽  
Mortality And Morbidity ◽  
Coronary Syndrome

Objective. This study was designed to investigate the effects of Desert Dust Storms and Climatological Factors on Mortality and Morbidity of Cardiovascular Diseases admitted to emergency department in Gaziantep. Method. Hospital records, obtained between September 01, 2009 and January 31, 2014, from four state hospitals in Gaziantep, Turkey, were compared to meteorological and climatological data. Statistical analysis was performed by Statistical Package for the Social Science (SPSS) for windows version 24.0. Results. 168,467 patients were included in this study. 83% of the patients had chest pain and 17% of patients had cardiac failure (CF). An increase in inpatient hospitalization due to CF was observed and corresponded to the duration of dust storms measured by number of days. However, there was no significant increase in emergency department (ED) presentations. There was no significant association of cardiac related mortality and coinciding presence of a dust storm or higher recorded temperature. The association of increases in temperature levels and the presence of dust storms with “acute coronary syndrome- (ACS-) related emergency service presentations, inpatient hospitalization, and mortality” were statistically significant. The relationship between the increase in PM10 levels due to causes unrelated to dust storms and the outpatient application, admission, and mortality due to heart failure was not significant. The increase in particle matter 10 (PM) levels due to causes outside the dust storm caused a significant increase in outpatient application, hospitalization, and mortality originated from ACS. Conclusion. Increased number of dust storms resulted in a higher prevalence of mortality due to ACS while mortality due to heart failure remained unchanged. Admission, hospitalization, and mortality due to chest pain both dependent and independent of ACS were increased by the presence of dust storms, PM10 elevation, and maximum temperature.

Abstract 115: Predictors Of A Positive Stress Test Among Patient Presenting To The Emergency Department With Chest Pain

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Taraka V Gadiraju ◽  
Jahnavi Sagi ◽  
Dev Basu ◽  
Srikanth Penumetsa ◽  
Michael Rothberg
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Stress Test ◽  
Tertiary Care ◽  
Face Validity ◽  
Pseudorandom Number Generator ◽  
Multivariable Model ◽  
Final Multivariable Model ◽  
Significant Difference ◽  
History Of

Objectives: Patients frequently present to the hospital with chest pain. Once myocardial infarction is ruled out based on EKG and cardiac enzymes, most patients undergo stress testing, but only few patients have a positive test. In ambulatory practice, age, sex and symptomatology can establish pretest probability of the coronary disease. However, there are no studies evaluating the predictors of a positive stress test in the emergency department (ED). We assessed predictors for a positive stress test in patients presenting to our hospital with chest pain. Methods: This is a case-control study conducted on a subset of patients admitted to our tertiary care center with chest pain between 2007 and 2009, and who had an inpatient stress test (n=1474). Using chart review, we identified 87 patients, whose stress tests were positive (abnormals), defined as presence of ischemia on EKG and/or imaging modalities. We then used a pseudorandom number generator to select 194 patients whose stress test results were normal (normals) for comparison. Clinical features of chest pain and CAD risk factors were abstracted from the medical record for comparison. A bivariable screening process was used to identify characteristics for inclusion in a multivariable predictive model. Sex and age were maintained in the model for face validity, and remaining covariates were removed in ascending order of their z-statistics until only those with a two-sided p-value of <0.10 remained. Stata 12.1 (Copyright 2011, StataCorp LP) was used for all analyses. Results: Patients with an abnormal stress test were older and more likely to be male and to have a history of vascular disease. Although patients with abnormal stress test were more likely to have history of hypertension, hyperlipidemia and current or ex-smoking, this difference was not statistically significant. Over half of the patients presented with non-cardiac chest pain and there was no significant difference in the chest pain characteristics between patients who had a normal and an abnormal stress test result. In the final multivariable model, when compared to the normals, abnormals were four times as likely to have a history of revascularization (OR 4.13, 95% CI 2.11, 8.09) and twice as likely to have a history of hyperlipidemia (OR 2.1, 95% CI 1.18, 3.79). They were also more likely to have an EKG suggestive of ischemia at presentation (OR 1.90, 95% CI 1.03, 3.53). Specificity of the model was 89%; sensitivity was 43%, and the c-statistic for the final multivariable model was 0.76, suggesting fair to good discrimination. Conclusions: Among patients presenting to the ED with chest pain, a past history of revascularization and hyperlipidemia and an EKG suggestive of ischemia may independently predict the likelihood of an abnormal stress test. Further validation of this model on an external dataset is necessary.

Abstract 16010: Congestive Heart Failure and Coronavirus Disease 2019 Illness Severity

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Max Ruge ◽  
Joanne Michelle D Gomez ◽  
Gatha G Nair ◽  
Setri Fugar ◽  
Jeanne du Fay de Lavallaz ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Congestive Heart Failure ◽  
Case Fatality ◽  
Severity Of Illness ◽  
Severe Infection ◽  
Severe Illness ◽  
Increased Risk ◽  
History Of ◽  
Male Sex

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has killed hundreds of thousands worldwide. Those with cardiovascular disease represent a vulnerable population with higher risk for contracting COVID-19 and worse prognosis with higher case fatality rates. Congestive heart failure (CHF) may lead to worsening COVID-19 symptoms. However, it is unclear if CHF is an independent risk factor for severe COVID-19 infection or if other accompanying comorbidities are responsible for the increased risk. Methods: From March to June 2020, data was obtained from adult patients diagnosed with COVID-19 infection who were admitted in the Rush University System for Health (RUSH) in Illinois. Heart failure patients, determined by ICD code assignments extracted from the electronic medical records, were identified. Multivariable logistic regression was performed between predictor variables and a composite outcome of severe infection consisting of Intensive Care Unit (ICU) admission, intubation, or in-hospital mortality. Results: In this cohort (n=1136), CHF [odds ratio (OR) 1.02] alone did not predict a more severe illness. Prior myocardial infarction [(MI), OR 3.55], history of atrial fibrillation [(AF), OR 2.14], and male sex (OR 1.55) were all significantly (p<0.001) associated with more severe COVID-19 illness course when controlling for CHF (Figure 1). In the 178 CHF patients, more advanced age (68.8 years vs. 63.8 years; p<0.05) and female sex (54.5% vs. 39.1%; p<0.05) were associated with increased severity of illness. Conclusions: Prior MI, history of AF, and male sex predicted more severe COVID-19 illness course in our cohort, but pre-existing heart failure alone did not. However, CHF patients who are females and older in age are at risk for severe infection. These findings help clinicians identify patients with comorbidities early at risk for severe COVID-19 illness.

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