scholarly journals Diagnostic Implications of an Elevated Troponin in the Emergency Department

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Maame Yaa Yiadom ◽  
Petr Jarolim ◽  
Cathy Jenkins ◽  
Stacy E. F. Melanson ◽  
Michael Conrad ◽  
...  
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Medical Records ◽  
Screening Test ◽  
Myocardial Injury ◽  
Troponin I ◽  
Type I ◽  
Elevated Troponin ◽  
Hospital Medical ◽  
Ed Visits

Objective. To determine the proportion of initial troponin (cTn) elevations associated with Type I MI versus other cardiovascular and noncardiovascular diagnoses in an emergency department (ED) and whether or not a relationship exists between the cTn level and the likelihood of Type I MI.Background. In the ED, cTn is used as a screening test for myocardial injury. However, the differential diagnosis for an initial positive cTn result is not clear.Methods. Hospital medical records were retrospectively reviewed for visits associated with an initial positive troponin I-ultra (cTnI), ≥0.05 μg/L. Elevated cTnI levels were stratified into low (0.05–0.09), medium (0.1–0.99), or high (≥1.0). Discharge diagnoses were classified into 3 diagnostic groups (Type I MI, other cardiovascular, or noncardiovascular).Results. Of 23,731 ED visits, 4,928 (21%) had cTnI testing. Of those tested, 16.3% had initial cTnI ≥0.05. Among those with elevated cTn, 11% were classified as Type I MI, 34% had other cardiovascular diagnoses, and 55% had a noncardiovascular diagnosis. Type I MI was more common with high cTnI levels (41% incidence) than among subjects with medium (9%) or low (6%).Conclusion. A positive cTn is most likely a noncardiovascular diagnosis, but Type I MI is far more common with cTnI levels ≥1.0.

scholarly journals Syndromic Surveillance of Emergency Department Visits for Acute Adverse Effects of Marijuana, Tri-County Health Department, Colorado, 2016-2017

2019 ◽  
Vol 134 (2) ◽  
pp. 132-140 ◽  
Author(s):  
Grace E. Marx ◽  
Yushiuan Chen ◽  
Michele Askenazi ◽  
Bernadette A. Albanese
Keyword(s):  
Emergency Department ◽  
Adverse Effects ◽  
Medical Records ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Marijuana Use ◽  
Emergency Department Visits ◽  
Diagnostic Codes ◽  
Icd 10 ◽  
Ed Visits

Objectives: In Colorado, legalization of recreational marijuana in 2014 increased public access to marijuana and might also have led to an increase in emergency department (ED) visits. We examined the validity of using syndromic surveillance data to detect marijuana-associated ED visits by comparing the performance of surveillance queries with physician-reviewed medical records. Methods: We developed queries of combinations of marijuana-specific International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes or keywords. We applied these queries to ED visit data submitted through the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) syndromic surveillance system at 3 hospitals during 2016-2017. One physician reviewed the medical records of ED visits identified by ≥1 query and calculated the positive predictive value (PPV) of each query. We defined cases of acute adverse effects of marijuana (AAEM) as determined by the ED provider’s clinical impression during the visit. Results: Of 44 942 total ED visits, ESSENCE queries detected 453 (1%) as potential AAEM cases; a review of 422 (93%) medical records identified 188 (45%) true AAEM cases. Queries using ICD-10 diagnostic codes or keywords in the triage note identified all true AAEM cases; PPV varied by hospital from 36% to 64%. Of the 188 true AAEM cases, 109 (58%) were among men and 178 (95%) reported intentional use of marijuana. Compared with noncases of AAEM, cases were significantly more likely to be among non-Colorado residents than among Colorado residents and were significantly more likely to report edible marijuana use rather than smoked marijuana use ( P < .001). Conclusions: ICD-10 diagnostic codes and triage note keyword queries in ESSENCE, validated by medical record review, can be used to track ED visits for AAEM.

Abstract 17183: Severity of Myocardial Injury in COVID-19 Hospitalized Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Saagar K Sanghvi ◽  
Logan Schwarzman ◽  
Noreen Nazir ◽  
Sreenivas Konda
Keyword(s):  
Inflammatory Markers ◽  
Myocardial Injury ◽  
Troponin I ◽  
Inflammatory Marker ◽  
Multivariate Regression Analysis ◽  
Cardiac Biomarkers ◽  
Primary Data ◽  
Elevated Troponin ◽  
Cardiac Decompensation ◽  
D Dimer

Introduction: Myocardial injury in COVID19 is reported as high as 30% and associated with worsened prognosis (Cooper et al., Circulation). Along with elevated cardiac biomarkers, elevated inflammatory markers of cytokine storm and hemophagocytic lymphohistiocytosis (HLH) are associated with increased illness severity and mortality. Our study aimed to identify patients at highest risk for myocardial injury and subsequent cardiac decompensation. Methods: 279 consecutive patients with COVID19 from a major metropolitan academic center, discharged from 3-21-2020 to 5-17-2020, were analyzed. Primary data includes age, sex, race, and peak troponin I during hospitalization. Patients were further stratified to evaluate severe cases with acute respiratory distress syndrome (ARDS) requiring intubation (n=40), and peak levels of CRP, ferritin, and D-dimer were collected. Bivariate and multivariate measures of association between peak inflammatory marker and troponin I levels were estimated. Results: Average age of ARDS population patients was 61 +/- 15 years; 50% male and 50% female. Self-identified African Americans(AA) were 35%, Hispanic/Latinos(H/L) were 55%, and Others including two White Americans were 10%. Average peak troponin I in H/L was remarkably higher 0.51 +/-1.16 compared to AA 0.18 +/- 0.23 and Others 0.13 +/- 0.16. Per multivariate regression analysis, D-dimer had the most significant effect on the elevated troponin (p=0.027). Although weakly significant, H/L showed elevated troponin (p =0.09) compared to non-H/L. Conclusion: Elevated D-dimer is associated with increased morbidity in COVID19, and also correlates with elevated troponin concerning for increased myocardial injury. Furthermore, the H/L population may be at greater risk for developing myocardial injury and have more injury as shown by higher troponin I levels. Larger studies may better assess the relation between inflammatory markers such as CRP and ferritin and myocardial injury. Our study provides evidence of systemic inflammation contributing to significant myocardial injury in COVID19, especially in the H/L population. Identifying patients at highest risk for myocardial injury early may allow for more effective medical interventions and improved outcomes.

scholarly journals Early evidence of SARS-CoV-2 in Milan, Jan-Feb 2020

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Gregorio P. Milani ◽  
Giovanni Casazza ◽  
Antonio Corsello ◽  
Paola Marchisio ◽  
Alessia Rocchi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Severe Acute Respiratory Syndrome ◽  
Medical Records ◽  
Northern Italy ◽  
The Other ◽  
Epidemiological Evidence ◽  
Early Evidence ◽  
Main Hospital ◽  
Ed Visits ◽  
A Minor

Abstract Background A few studies have suggested that the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) was present in Northern Italy several weeks before its official detection on February 21, 2020. On the other hand, no clinical data have been provided so far to support such hypothesis. We investigated clinical-epidemiological evidence of SARS-CoV-2 infection among children and adults referring to emergency department (ED) in the main hospital of the center of Milan (Italy) before February 21, 2020. Methods A retrospective analysis of medical records of ED visits at the Fondazione Ca′ Granda Policlinico, Milan between January 11 and February 15 in 2017, 2018, 2019 and in 2020 was performed. The number of subjects referring with fever, cough or dyspnea was compared between the studied period of 2020 and the previous 3 years, by calculating a standardized referral ratio (SRR, number of observed cases in 2020 divided by the number of expected cases according to 2017–2019) and the corresponding 95% confidence interval (CI). Results In the pediatric ED, 7709 (average 2570/year) and 2736 patients were visited during the period 2017–2019 and in the 2020, respectively. Among adults, 13,465 (average 4488/year) and 4787 were visited during the period 2017–2019 and in the 2020, respectively. The SRR was 1.16 (95% CI 1.10–1.23) in children and 1.25 (95% CI 1.16–1.35) in adults. The ratio for the two (children and adults) SRRs was 0.93 (0.84–1.02), suggesting a trend towards a higher frequency in adults compared to children. Conclusions This study suggests that SARS-CoV-2 might have spread in Milan before February 21, 2020 with a minor trend among children.

scholarly journals Clinical and diagnostic significance of biochemical markers of myocardial lesions after planned coronary surgery

2017 ◽  
Vol 95 (8) ◽  
pp. 700-704
Author(s):  
Evgenya G. Uchasova ◽  
A. A. Shilov ◽  
O. V. Gruzdeva ◽  
V. I. Ganyukov ◽  
A. A. Kuz’mina ◽  
...  
Keyword(s):  
Myocardial Injury ◽  
Troponin I ◽  
Myocardial Revascularization ◽  
Myocardial Necrosis ◽  
Fold Increase ◽  
Elevated Troponin ◽  
Diagnostic Significance ◽  
Percutaneous Coronary ◽  
Proven Efficacy ◽  
Myocardial Lesions

In recent years, percutaneous coronary interventions (PCI) have become the preferred method for the treatment of patients with coronary heart disease. Despite the proven efficacy of PCI, it can be associated with myocardial infarction. Purpose. To study the significance of increased concentration of various biomarkers of myocardial injury for verification of its diagnosis after planned PCI. Materials and methods. The study included 103 subjects who underwent planned myocardial revascularization in the form of PCI. Blood samples for analysis of myocardial necrosis markers (myoglobin, Troponin I, CK-MB) were taken before and 24 hours after PCI. Results. After PCI, the Troponin I content increased in 36 (35%) subjects within the range from 0.05 to 0.25 ng/ml. Troponin I concentration increased in 21 (20.3%) subjects to more than 0.25 n/ml (a higher than 5-fold increase of 99 percentile). CK-MB level increased in 56 subjects up to the 5-fold rise in 99 percentile (<21.5ng/ml) and 3 subjects showed more than 5-fold increase of 99 percentile as compared to the baseline. 37 subjects underwent PCI for the management of technically complicated coronary bed lesions (С and B2 types of coronary arteries’ lesions). In 9 out of the 37 subjects (24.3%), a significant increase in Troponin I level was documented, other 28 (75.7 %) subjects did not experience the 5-fold increase of Troponin I. In 12 (18.2%) patients with morphologically uncomplicated coronary bed anatomy, a significant increase in Troponin I was registered Conclusion. After a planned PC, an increase of Troponin I and CK-MB levels occurs in 55-58% of the patients. A significant 5-fold increase of Troponin I level (without additional criteria of MI diagnosis) occurs more often than a rise in the CK-MB level. A planned PCI is accompanied by elevated Troponin I levels regardless of the complexity of coronary bed lesion.

scholarly journals Clinical Significance of Increased Serum Levels of Troponin I in Patients from the Emergency Department of a County Hospital

2020 ◽  
Vol 71 (2) ◽  
pp. 68-73
Author(s):  
Paul-Mihai Boarescu ◽  
Ioana Chirila ◽  
Adriana Elena Bulboaca ◽  
Razvan Olimpiu Mada ◽  
Cerasela Mihaela Goidescu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Clinical Significance ◽  
Myocardial Injury ◽  
Troponin I ◽  
White Blood Cells ◽  
Laboratory Data ◽  
Serum Levels ◽  
Discharge Diagnosis ◽  
Group 2

Elevated cardiac troponin I (cTnI) levels are diagnostic for myocardial injury. Moreover, they are essential for risk stratification in patients with acute cardiac ischemia and heart failure. However, their usefulness is not limited to the previous clinical conditions. The aim of this study was to evaluate the clinical significance of cTnI levels in the emergency department.In 324 patients, out of the 4147 referred to the emergency department, serum levels of cTnI were evaluated and represented the study population. Subjects were divided into 2 groups: Group 1 (66 patients) with cTnI ≥ 0.04 ng/mL and Group 2 (258 patients) with cTnI level [ 0.04 ng/mL. The clinical characteristics, laboratory data, ECG findings, echocardiographic abnormalities and discharge diagnosis were compared between the two groups. Patients with cTnI ≥0.04 ng/mL had more often a history of ischemic heart disease, lower levels of oxygen saturation, higher levels of blood glucose, increased white blood cells count, higher heart rate and deeper ST-segment depressions on ECG. The most common discharge diagnosis was heart failure. Although an elevated level of cTnI is highly suggestive for myocardial injury, it should always be interpretated in the clinical context. Heart failure is an important diagnosis in patients with elevated cTnI levels.

scholarly journals Lipothymia and Syncope—Aetiology and Outcome in a Prehospital Setting: A Retrospective Study

2012 ◽  
Vol 2012 ◽  
pp. 1-6
Author(s):  
Stine T. Zwisler ◽  
Søren Mikkelsen
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Medical Records ◽  
Prehospital Setting ◽  
Hospital Medical ◽  
Prehospital Diagnosis

Background. A firm aetiology of lipothymia or syncope can be difficult to establish prehospitally. The aim of the study was to investigate patients initially assigned the diagnosis of lipothymia or syncope prehospitally and establish the aetiology of their condition either based on prehospital or in-hospital medical records. Methods. From May 1, 2006 to April 30, 2010, all patients receiving the diagnosis of lipothymia or syncope by the MECU were investigated. If admitted to hospital, the patients’ medical records were investigated to confirm the prehospital diagnosis. Results. Within 17980 MECU runs registered, 678 were assignments in which the patients were diagnosed with lipothymia or syncope (3.8%). 578 patients (85%) were admitted to hospital. 278 of the patients were discharged directly from the emergency department, while 271 were admitted to a ward. 112 patients refused treatment offered by the MECU or at the emergency department, died, or were left at the scene following treatment. 17 were lost to followup. Of all patients investigated, 299 were discharged with the diagnosis of lipothymia or syncope. 250 patients were discharged with other diagnoses. Conclusions. In 44% of the patients presenting with lipothymia or syncope, no other diagnosis was established at the hospital, and no explanatory aetiology was found.

scholarly journals 50-year-old Male With Chest Pain

2019 ◽  
Vol 3 (4) ◽  
pp. 321-326
Author(s):  
William Fernandez ◽  
Laura Bontempo ◽  
Zachary Dezman
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Troponin I ◽  
Shortness Of Breath ◽  
Upper Limit ◽  
Work Up

A 50-year-old male presented to the emergency department with four days of intermittent chest pain and shortness of breath, which progressively worsened in severity. Testing revealed a troponin I greater than 100 times the upper limit of normal and an electrocardiogram with non-specific findings. This case takes the reader through the differential diagnosis and systematic work-up of the deadly causes of chest pain, ultimately leading to this patient’s diagnosis.

scholarly journals Elevated troponin I levels in acute liver failure: Is myocardial injury an integral part of acute liver failure?

Hepatology ◽  
2007 ◽  
Vol 45 (6) ◽  
pp. 1489-1495 ◽  
Author(s):  
Nimisha K. Parekh ◽  
Linda S. Hynan ◽  
James De Lemos ◽  
William M. Lee ◽  
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Myocardial Injury ◽  
Troponin I ◽  
Elevated Troponin
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