Satisfacción y rendimiento académico en los estudiantes de medicina de urgencia tras implementar un modelo docente basado en aula invertida / Satisfaction and academic performance of students of emergency medicine in a learning model based on a flipped classroom

No disponible

[Usefulness of NTproBNP in the emergency management of patients with severe dyspnea and an uncertain heart failure diagnosis]. / Utilidad del NTproBNP en el manejo urgente del paciente con disnea severa y diagnóstico dudoso de insuficiencia cardíaca.

INTRODUCTION AND OBJECTIVES: Measurement of N-terminal pro-B-type natriuretic peptide (NTproBNP) helps in diagnosing heart failure (HF). The test's usefulness may be greatest in patients with severe dyspnea of uncertain origin. However, NTproBNP has not been evaluated specifically in this setting. PATIENTS AND METHOD: This prospective emergency department study included 70 patients with shortness of breath at rest as their chief complaint. In the attending physician's opinion, both HF and a non-cardiac cause were equally probable. Blinded NTproBNP measurement was carried out in blood samples collected on admission. Patients were monitored and their final diagnoses were based on clinical findings, therapeutic responses, and cardiac and noncardiac tests performed during hospitalization. RESULTS: The NTproBNP level was higher in the 49 patients (70%) with a final diagnosis of HF (P = .006); the area under the ROC curve was 0.72 (0.60-0.82). The optimum diagnostic cut-off value was 900 pg/mL, which had an accuracy of 87%, a sensitivity of 98%, and a negative predictive value of 92%. The NTproBNP level was significantly higher in the 6 patients (9%) who died during hospitalization (P = .009); the area under the ROC curve was 0.87 (0.76-0.93) and the optimum cut-off value for predicting death was 5500 pg/mL, which had an accuracy of 77%, a sensitivity of 100%, and a positive likelihood ratio of 4.2. CONCLUSIONS: In patients with severe dyspnea and an uncertain diagnosis of HF, an NTproBNP level < 900 pg/mL helps exclude the presence of HF, whereas a NTproBNP level > 5500 pg/mL identifies patients at an increased risk of death.

Utilidad del NTproBNP en el manejo urgente del paciente con disnea severa y diagnóstico dudoso de insuficiencia cardíaca / Usefulness of NTproBNP in the emergency management of patients with severe dyspnea and an uncertain heart failure diagnosis

Introducción y objetivos. El NTproBNP ayuda a identificar a los pacientes con insuficiencia cardíaca. Su utilidad podría ser máxima en pacientes con disnea severa de origen incierto; sin embargo, esta población no ha sido específicamente evaluada. Pacientes y método. Estudio prospectivo de 70 pacientes que acudieron a urgencias refiriendo disnea de reposo, cuyo diagnóstico clínico inicial fue establecido como dudoso, con probabilidad intermedia de insuficiencia cardíaca. A la llegada a urgencias se extrajeron las muestras analíticas y se determinó el valor de NTproBNP de forma ciega. Los pacientes fueron controlados y el diagnóstico final se estableció sobre la base de los hallazgos clínicos, la respuesta al tratamiento y las pruebas practicadas durante el curso hospitalario. Resultados. El NTproBNP fue mayor en los 49 pacientes (70%) con un diagnóstico final de insuficiencia cardíaca (p = 0,006), obteniendo un área bajo la curva ROC de 0,72 (0,60-0,82). El valor de corte diagnóstico óptimo fue 900 pg/ml, con una precisión del 87%, una sensibilidad del 98% y un valor predictivo negativo del 92%. En los 6 pacientes (9%) fallecidos durante la hospitalización, el NTproBNP fue significativamente mayor (p = 0,009), con un área bajo la curva ROC de 0,87 (0,76-0,93) y un valor de corte pronóstico óptimo de 5.500 pg/ml, con una precisión del 77%, una sensibilidad del 100% y una razón de probabilidad positiva de 4,2. Conclusiones. En una población con disnea severa que acude a urgencias con diagnóstico dudoso de insuficiencia cardíaca, un valor de NTproBNP 5.500 pg/ml identifica a los pacientes con un mayor riesgo de muerte hospitalaria

Introduction and objectives. Measurement of N-terminal pro-B-type natriuretic peptide (NTproBNP) helps in diagnosing heart failure (HF). The test's usefulness may be greatest in patients with severe dyspnea of uncertain origin. However, NTproBNP has not been evaluated specifically in this setting. Patients and method. This prospective emergency department study included 70 patients with shortness of breath at rest as their chief complaint. In the attending physician's opinion, both HF and a non-cardiac cause were equally probable. Blinded NTproBNP measurement was carried out in blood samples collected on admission. Patients were monitored and their final diagnoses were based on clinical findings, therapeutic responses, and cardiac and noncardiac tests performed during hospitalization. Results. The NTproBNP level was higher in the 49 patients (70%) with a final diagnosis of HF (P=.006); the area under the ROC curve was 0.72 (0.60-0.82). The optimum diagnostic cut-off value was 900 pg/mL, which had an accuracy of 87%, a sensitivity of 98%, and a negative predictive value of 92%. The NTproBNP level was significantly higher in the 6 patients (9%) who died during hospitalization (P=.009); the area under the ROC curve was 0.87 (0.76-0.93) and the optimum cut-off value for predicting death was 5500 pg/mL, which had an accuracy of 77%, a sensitivity of 100%, and a positive likelihood ratio of 4.2. Conclusions. In patients with severe dyspnea and an uncertain diagnosis of HF, an NTproBNP level 5500 pg/mL identifies patients at an increased risk of death