Dor torácica na sala de emergência: a importância de uma abordagem sistematizada / Chest pain in the emergency room: importance of a systematic approach
Arq. bras. cardiol
; 74(1): 13-29, Jan. 2000. tab, graf
Artigo
em Português, Inglês
| LILACS
| ID: lil-262251
Biblioteca responsável:
BR1.1
RESUMO
OBJECTIVE:
To evaluate the efficiency of a systematic diagnostic approach in patients with chest pain in the emergency room in relation to the diagnosis of acute coronary syndrome (ACS) and the rate of hospitalization in high-cost units.METHODS:
One thousand and three consecutive patients with chest pain were screened according to a pre-established process of diagnostic investigation based on the pre-test probability of ACS determinate by chest pain type and ECG changes.RESULTS:
Of the 1003 patients, 224 were immediately discharged home because of no suspicion of ACS (route 5) and 119 were immediately transferred to the coronary care united because of ST elevation or left bundle-branch block (LBBB) (route 1) (74 per cent of these had a final diagnosis of acute myocardial infarction [AMI]). Of the 660 patients that remained in the emergency room under observation, 77 (12 per cent) had AMI without ST segment elevation and 202 (31 per cent) had unstable angina (UA). In route 2 (high probability of ACS) 17 per cent of patients had AMI and 43 per cent had UA, whereas in route 3 (low probability) 2 per cent had AMI and 7 per cent had UA. The admission ECG has been confirmed as a poor sensitivity test for the diagnosis of AMI ( 49 per cent), with a positive predictive value considered only satisfactory (79 per cent).CONCLUSION:
A systematic diagnostic strategy, as used in this study, is essential in managing patients with chest pain in the emergency room in order to obtain high diagnostic accuracy, lower cost, and optimization of the use of coronary care unit beds.
Texto completo:
Disponível
Coleções:
Bases de dados internacionais
Contexto em Saúde:
Agenda de Saúde Sustentável para as Américas
Problema de saúde:
Objetivo 4: Financiamento para a saúde
Base de dados:
LILACS
Assunto principal:
Dor no Peito
/
Baixo Débito Cardíaco
/
Serviços Médicos de Emergência
Tipo de estudo:
Estudo diagnóstico
/
Avaliação econômica em saúde
/
Estudo prognóstico
Limite:
Feminino
/
Humanos
/
Masculino
Idioma:
Inglês
/
Português
Revista:
Arq. bras. cardiol
Assunto da revista:
Cardiologia
Ano de publicação:
2000
Tipo de documento:
Artigo
País de afiliação:
Brasil