Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department.

Pediatric chest pain is a common chief complaint in the emergency department. Not surprisingly, children with chest pain are usually brought to the emergency department by their parents out of fear of heart disease. However, chest pain in the pediatric population is generally a benign disease. In this review, we have identified musculoskeletal pain as the most prevalent etiology of chest pain in the pediatric population, accounting for 38.7-86.3% of cases, followed by pulmonary (1.8-12.8%), gastrointestinal (0.3-9.3%), psychogenic (5.1-83.6%), and cardiac chest pain (0.3-8.0%). Various diagnostic procedures are commonly used in the emergency department for cardiac chest pain, including electrocardiogram (ECG), chest radiography, cardiac troponin examination, and echocardiography. However, these examinations demonstrate limited sensitivity in identifying cardiac etiologies, with sensitivities ranging from 0 to 17.8% for ECG and 11.0 to 17.2% for chest radiography. To avoid the overuse of these diagnostic tools, a well-designed standardized algorithm for pediatric chest pain could decrease unnecessary examination without missing severe diseases.

Methodological flaws in"diagnostic accuracy of blood biomarkers for Alzheimer's disease and amnestic mild cognitive impairment: A meta-analysis".

We read with interest the review by Chen et al. They intended to examine the diagnostic accuracy of blood-based biomarkers for detecting Alzheimer's disease and amnestic mild cognitive impairment. We believe that there were substantial methodological flaws in their meta-analysis. These methodological flaws included no comprehensive literature search details, neglect of the negative result research, no prespecified cut-off values, erroneous data input in their meta-analysis, and the issue of prevalence determined by the included studies. These factors potentially contributed to overestimation of the discriminative accuracy of blood-based biomarkers. Subsequently, the conclusion that blood-based biomarkers are effective tools for detecting Alzheimer's disease is debatable without correction of these methodological flaws and providing robust and trustworthy estimates.

The factor influencing the rate of ROSC for nontraumatic OHCA in New Taipei city.

ABSTRACT: Return of spontaneous circulation (ROSC) from out-of-hospital cardiac arrest (OHCA) is critical for the Emergency Medical Services System. When compared to other developed countries, Taiwan has lower rate of ROSC in OHCA patients.We conducted a retrospective study of cardiac arrest using The Emergency Medical Service Dispatching Center in Northern Taiwan and The Prehospital Care System of New Taipei City Paramedic Service. Patients suffering from nontraumatic OHCA between August of 2019 to February of 2020 were included. We analyzed the cardiopulmonary resuscitation (CPR) quality parameters such as chest compression interruptions, bystander CPR, shockable rhythm, CPR interruption, chest compression fraction (CCF) average, patient transportation in buildings, and adrenaline injection during CPR. Multivariable logistic regression analysis was performed to assess the relationship between potential independent variables and ROSC.In our study, we involved 1265 subjects suffering from nontraumatic OHCA, among which 587 patients met inclusion criteria. We identified that CCF> 0.8, chest compression interruption greater than 3 times, and patient transportation in the building were the most critical factors influencing ROSC. However, patient transportation in a building was identified as a dependent predictor variable (P = .4752).We concluded that CCF > 0.8 and chest compression interruption greater than 3 times were essential factors affecting the CPR ROSC rate. The most significant reason for suboptimal CCF and CPR interruption is patient transportation in a building. Improving the latter point could facilitate high-quality CPR.

Woman with recurrent vomiting.

CLINICAL INTRODUCTION: A 69-year-old woman presented to the ED with a chief complaint of recurrent vomiting for 3 weeks. She was afebrile, blood pressure was 100/67 mm Hg, HR was 114/min, RR was 19/min and oxygen saturation was 98%. On physical examination, she had mild epigastric tenderness without guarding. Blood tests were normal except for hyponatraemia of 128 mmol/L and hypokalaemia of 2.7 mmol/L. The ECG demonstrated sinus tachycardia with first-degree atrioventricular block. Chest radiograph posteroanterior view (CXR) was performed (figure 1).emermed;35/11/691/F1F1F1Figure 1Chest radiograph posteroanterior view. The patient presented to the ED with a complaint of recurrent vomiting for 3 weeks. QUESTION: Due to continuous vomiting of this patient, which of the following is the most appropriate management?Abdominal ultrasonography.Chest and abdominal CT.Barium swallow.Oesophagogastroduodenoscopy (EGD). For answer see page 02 For question see page 01.