RESUMO
BACKGROUND: High sensitivity troponin assays have become widespread for emergency department evaluation of acute chest pain. We assessed if a high sensitivity troponin under the 99th percentile upper reference limit drawn at 6 h or greater from symptom onset could safely rule out acute coronary syndrome in patients who did not meet the rapid rule-out strategy. METHODS: We conducted a multicenter retrospective study examining emergency department patients with chest pain who did not meet rapid-rule out criteria and were admitted for further evaluation. Among these admitted patients, we assessed the rate of clinically relevant adverse cardiac events (death, cardiac or respiratory arrest, STEMI, or life-threatening arrhythmia) and NSTEMI in patients with high sensitivity troponin less than the 99th percentile value obtained after at least 6 h of chest pain. RESULTS: Out of 1187 patients admitted, we found 30 clinically relevant adverse cardiac events, all of which occurred in patients admitted for another compelling reason or ischemic ECG. 36 patients had an NSTEMI, of which 33 were identified with high sensitivity troponin greater than 99th percentile upper reference limit within 6 h of chest pain onset. This left 0 clinically relevant adverse cardiac events and 3 NSTEMI among the 429 patients with high sensitivity troponin less than the 99th percentile at 6 h and nonischemic ECG and no other compelling reason for admission. CONCLUSION: This study assessed patients with chest pain with high sensitivity troponin values between 3 ng/L and the 99th percentile upper reference limit after 6 h of chest pain and found that they have a low rate of clinically relevant adverse cardiac events and NSTEMI.
Assuntos
Infarto do Miocárdio , Infarto do Miocárdio sem Supradesnível do Segmento ST , Humanos , Troponina I , Estudos Retrospectivos , Infarto do Miocárdio/diagnóstico , Biomarcadores , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Troponina T , Sensibilidade e EspecificidadeAssuntos
Vértebras Cervicais/diagnóstico por imagem , Dor/diagnóstico , Falha de Prótese/efeitos adversos , Doenças da Medula Espinal/diagnóstico , Fusão Vertebral/instrumentação , Placas Ósseas/efeitos adversos , Vértebras Cervicais/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Dor/etiologia , Parafusos Pediculares/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Próteses e Implantes/efeitos adversos , Radiografia/métodos , Reoperação/métodos , Doenças da Medula Espinal/etiologia , Fusão Vertebral/efeitos adversos , Resultado do TratamentoRESUMO
Urinary tract infections (UTIs) in children are commonly seen in the emergency department and pose several challenges to establishing the proper diagnosis and determining management. This article reviews pediatric UTI and addresses epidemiology, diagnosis, treatment, and imaging, and their importance to the practicing emergency medicine provider. Accurate and timely diagnosis of pediatric UTI can prevent short-term complications, such as severe pyelonephritis or sepsis, and long-term sequelae including scarring of the kidneys, hypertension, and ultimately chronic renal insufficiency and need for transplant.
