Valor de la ecografia de extremidades inferiores para el diagnostico de la trombosis venosa profunda en un servicio de urgencias / Value of ultrasound imaging of the lower limbs for diagnosing deep vein thrombosis

Objetivos: Describir las caracteristicas de los pacientes con trombosis venosa profunda(VTP); valorar la concordancia entre la (..)(AU)

Objectives: 1) To describe the characteristics of patients with these symptoms. 2) To assess agreement between compression ultrasonography performed in the ED and Doppler ultrasound imaging in radiology. 3) To assess the efficacy of a diagnostic algorithm that includes ultrasound imaging, clinical characteristics, and laboratory findings. Methods: Descriptive study of consecutive patients attending the ED complaining of symptoms suggestive of DVT. We applied a diagnostic algorithm requiring physical examination, D-dimer assessment, pretest probability (Wells score), and ED compression ultrasonography. Results: Thirty-seven patients were included; 48.65% were men. Pretest probability according to the Wells score was low for 9 patients (24.3%; 95% confidence interval [CI], 9.1%-39.5%), moderate for 10 (27.0%; 95% CI, 11.4%-42.7%),and high for 18 (48.6%; 95% CI, 31.2%-66.1%). D-dimer level was not significantly associated with the findings of compression ultrasonography. The ¦Ê index for agreement between compression ultrasonography and the gold standard(Doppler ultrasound in the radiology department) was 1. Sensitivity was 100% (95% CI, 96.1%-100%), specificity91.7% (95% CI, 71.9%-100%) , positive predictive value 92.9% (95% CI, 75.8%-100%), and negative predictive value100% (95% CI, 95.4%-100%).Conclusions: The algorithm tested appears to be valid for evaluating patients who may have DVT. There is a high level of agreement between compression ultrasonography of the lower extremities in the ED and ultrasound findings reported by the radiology department (AU)

[A prospective study on the time elapsed until admission at the coronary unit of patients with acute myocardial infarct. Apropos of 180 cases]. / Estudio prospectivo sobre el tiempo transcurrido hasta el ingreso en la unidad coronaria de los enfermos con infarto agudo de miocardio. A propósito de 180 casos.

We have carried out a prospective study to evaluate the time from the onset of symptoms until the admission to coronary care unit in 180 patients with acute myocardial infarction. We have evaluated the causes resulting in a delay and their consequences on the prognosis. The data were obtained with a clinical questionnaire from the patients and/or his family and from a review of the clinical records. The mean time since the onset of symptoms until the admission to the coronary care unit was 5.4 hours, being significantly shorter in the patients who did not call for prehospital attention. The major delay was attributable to the patient (delay in asking for medical attention); therefore, it is mandatory to implement measures of health education. Prehospital attention did not provide any diagnostic or therapeutic improvement in 30% of patients. Thus, we suggest that community care education on coronary artery disease should be improved.