Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 6 de 6
Filtrar
Mais filtros










Tipo de estudo
Intervalo de ano de publicação
1.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 9-18, feb. 2020. graf, tab
Artigo em Espanhol | LILACS-Express | ID: ibc-ET2-3431

RESUMO

Objetivos. Analizar qué características clínicas y del ECG de la primera valoración de pacientes con dolor torácico no traumático (DNT) se asocian con una clasificación inicial de sospecha de síndrome coronario agudo (SCA) y con el diagnóstico final de SCA, e identificar cuáles resultan sobre o infravaloradas durante la clasificación inicial. Método. Se incluyeron las consultas consecutivas por DTNT en una unidad de dolor torácico durante 10 años (2008-2017) en las que se disponía de los diagnósticos inicial de sospecha (SCA/no SCA) y final de alta de urgencias (SCA/no SCA). Se incluyeron 33 variables independientes (2 demográficas, 5 comorbilidad cardiovascular, 22 dolor torácico, 4 datos ECG). Se calcularon las odds ratio (OR) para la clasificación (inicial y final) como SCA para cada variable independiente, crudas y ajustadas en modelos globales que incluían todas ellas. En estos modelos ajustados se comparó si las OR para la clasificación inicial y final como SCA eran significativamente diferentes. Resultados. Se incluyeron 34.552 visitas. Las 33 variables analizadas mostraron asociación significativa para la clasificación inicial y final del DTNT como SCA, y en muchos casos esta asociación se mantuvo en el modelo ajustado. Diecinueve variables mostraron OR significativamente diferentes para la sospecha inicial de SCA que para el diagnóstico final de SCA: 10 sobrestimaban la asociación final y 9 la subestimaban. Conclusión. Los datos clínicos iniciales clásicamente utilizados para sospechar SCA pacientes con DTNT en urgencias identifican todos ellos individualmente a pacientes con riesgo incrementado de ser clasificado inicial y finalmente como SCA; sin embargo, algunos de ellos sobreestiman y otros subestiman inicialmente el riesgo final. Los urgenciólogos debieran sensibilizarse más con estos datos subestimados


Objectives. To analyze clinical data and electrocardiographic (ECG) findings obtained during the initial evaluation of patients with nontraumatic chest pain (NTCP). To explore associations between these findings and the initial and final diagnoses of acute coronary syndrome (ACS). To assess which variables initially over- or underestimate risk ACS. Methods. Consecutive patients with NTCP attended in a chest pain unit during the 10-year period of 2008–2017 were included if the suspected and discharge diagnoses of interest (ACS or non-ACS) had been recorded. Thirtythree independent variables (demographic, 2; cardiovascular, 5; chest pain, 22; ECG, 4). We included all variables in models to calculate crude and adjusted odds ratios (ORs) between each independent variable and the initial and final diagnoses. The adjusted ORs were compared to determine whether the initial and final diagnoses of ACS differed significantly in relation to the variables. Results. A total of 34 552 patient visits were attended. The ORs for the 33 variables were significantly associated with initial and final NTCP classification as ACS or non-ACS, and in many cases the association was confirmed by the adjusted ORs. The adjusted ORs for 19 variables were significantly different in their relation to the initial and final diagnoses of ACS: 10 overpredicted the probability of the diagnosis and 9 underpredicted it. Conclusions. The variables traditionally used to warn of ACS in emergency patients with NTCP identify individuals likely to be initially and finally diagnosed with ACS. However, some of these variables overestimate or underestimate the risk of a final ACS diagnosis. Emergency medicine physicians should be aware of variables associated with underestimation of risk

2.
Emergencias ; 32(1): 9-18, 2020 Feb.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31909907

RESUMO

OBJECTIVES: To analyze clinical data and electrocardiographic (ECG) findings obtained during the initial evaluation of patients with nontraumatic chest pain (NTCP). To explore associations between these findings and the initial and final diagnoses of acute coronary syndrome (ACS). To assess which variables initially over- or underestimate risk ACS. MATERIAL AND METHODS: Consecutive patients with NTCP attended in a chest pain unit during the 10-year period of 2008-2017 were included if the suspected and discharge diagnoses of interest (ACS or non-ACS) had been recorded. Thirtythree independent variables (demographic, 2; cardiovascular, 5; chest pain, 22; ECG, 4). We included all variables in models to calculate crude and adjusted odds ratios (ORs) between each independent variable and the initial and final diagnoses. The adjusted ORs were compared to determine whether the initial and final diagnoses of ACS differed significantly in relation to the variables. RESULTS: A total of 34 552 patient visits were attended. The ORs for the 33 variables were significantly associated with initial and final NTCP classification as ACS or non-ACS, and in many cases the association was confirmed by the adjusted ORs. The adjusted ORs for 19 variables were significantly different in their relation to the initial and final diagnoses of ACS: 10 overpredicted the probability of the diagnosis and 9 underpredicted it. CONCLUSION: The variables traditionally used to warn of ACS in emergency patients with NTCP identify individuals likely to be initially and finally diagnosed with ACS. However, some of these variables overestimate or underestimate the risk of a final ACS diagnosis. Emergency medicine physicians should be aware of variables associated with underestimation of risk.

3.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 377-384, dic. 2019. graf, tab
Artigo em Espanhol | LILACS-Express | ID: ibc-ET2-3122

RESUMO

Objetivo. Analizar la evolución de las características epidemiológicas de las visitas atendidas de forma consecutiva en una unidad de dolor torácico (UDT) de un servicio de urgencias hospitalario (SUH) durante un periodo de 10 años. Método. Se incluyeron todas las visitas por dolor torácico no traumático (DTNT), analizándose la evolución temporal de las características epidemiológicas, de la clasificación diagnóstica inicial (evaluación clínica inicial y electrocardiograma) y final (al alta de la UDT), y los tiempos necesarios para alcanzar las mismas. Resultados. Se incluyeron 34.552 pacientes consecutivos con una edad media 59 (DE: 13) años, el 42% mujeres. Se observó un incrementó en el número anual de visitas a la UDT (p < 0,001), menor afluencia los meses de verano (p < 0,001), y mayor los días laborables (p < 0,001) y de 8-16 horas (p < 0,001). Se comprobó que progresivamente más pacientes eran mujeres (+0,29% anual, p < 0,05), menores de 50 años (+0,92%, p < 0,001), con más factores de riesgo cardiovascular, menos antecedentes de cardiopatía isquémica y con DTNT menos sugestivo de síndrome coronario agudo (SCA). La clasificación diagnóstica inicial y final descartó SCA en un 52,2% y un 80,4% de pacientes, respectivamente, hecho que aumentó progresivamente durante el periodo evaluado (+1,86%, p < 0,001; y +0,56%, p = 0,04; respectivamente). El tiempo de clasificación inicial no se modificó, pero se incrementó el necesario para la clasificación final (p < 0,001), que resultó superior en pacientes con diagnostico final de SCA (p < 0,001). Conclusión. Se observa un mayor uso de la UDT tras su creación, causado por un incremento de pacientes con DTNT de características no típicamente coronarias, disminuyendo el porcentaje de clasificados inicial y finalmente como debidos a SCA


Objective. To analyze changes in the characteristics of consecutively treated patients attended in the chest pain unit of a hospital emergency department over a 10-year period. Methods. All patients presenting with nontraumatic chest pain (NTCP) were included. We analyzed changes over time in epidemiologic characteristics, initial diagnostic classification (on clinical and electrocardiographic evaluation), final diagnosis (on discharge), and time until these diagnoses. Results. A total of 34 552 consecutive patients with a mean (SD) age of 59 (13) years were included; 42% were women. The annual number of visits rose over time. Visits were fewer in summer and more numerous on workdays and between the hours of 8 AM and 4 PM (P<.001, both comparisons). The number of women increased over time (up 0.29% annually, P<.05) as did the number of patients under the age of 50 years (up 0.92% annually, P<.001). With time, patients had fewer cardiovascular risk factors and less often had a history of ischemic heart disease. Fewer cases of NTCP had signs suggestive of acute coronary syndrome (ACS). ACS was ruled out at the time of initial and final diagnoses in 52.2% and 80.4%, respectively, and these percentages which rose over the 10-year period by 1.86% (P<.001) and 0.56% (P=.04). Time to initial diagnosis did not change. However, time to final diagnosis did increase (P<.001), and the delay was longer in patients diagnosed with ACS (P<.001). Conclusions. The chest pain unit was more active at the end of the period, in keeping with the increase in patients with NTCP whose characteristics were not typical of coronary disease. The percentages of patients initially and finally diagnosed with ACS decreased with time

4.
Emergencias ; 31(6): 377-384, 2019.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31777208

RESUMO

OBJECTIVES: To analyze changes in the characteristics of consecutively treated patients attended in the chest pain unit of a hospital emergency department over a 10-year period. MATERIAL AND METHODS: All patients presenting with nontraumatic chest pain (NTCP) were included. We analyzed changes over time in epidemiologic characteristics, initial diagnostic classification (on clinical and electrocardiographic evaluation), final diagnosis (on discharge), and time until these diagnoses. RESULTS: A total of 34 552 consecutive patients with a mean (SD) age of 59 (13) years were included; 42% were women. The annual number of visits rose over time. Visits were fewer in summer and more numerous on workdays and between the hours of 8 AM and 4 PM (P<.001, both comparisons). The number of women increased over time (up 0.29% annually, P<.05) as did the number of patients under the age of 50 years (up 0.92% annually, P<.001). With time, patients had fewer cardiovascular risk factors and less often had a history of ischemic heart disease. Fewer cases of NTCP had signs suggestive of acute coronary syndrome (ACS). ACS was ruled out at the time of initial and final diagnoses in 52.2% and 80.4%, respectively, and these percentages which rose over the 10-year period by 1.86% (P<.001) and 0.56% (P=.04). Time to initial diagnosis did not change. However, time to final diagnosis did increase (P<.001), and the delay was longer in patients diagnosed with ACS (P<.001). CONCLUSION: The chest pain unit was more active at the end of the period, in keeping with the increase in patients with NTCP whose characteristics were not typical of coronary disease. The percentages of patients initially and finally diagnosed with ACS decreased with time.

5.
Emergencias (St. Vicenç dels Horts) ; 20(6): 399-404, nov.-dic. 2008. tab
Artigo em Espanhol | IBECS | ID: ibc-70069

RESUMO

Objetivo: Valorar si existen diferencias en la aproximación diagnóstica del dolor torácico en un servicio de urgencias hospitalario (SUH) en función del género. Método: Pacientes consecutivos visitados en la unidad de dolor torácico de un SUH durante16 meses. Tras la primera valoración y el electrocardiograma, los pacientes se clasificaron en cuatro protocolos diferentes: P1 (síndrome coronario agudo (SCA) con elevación del ST); P2 (SCA con descenso del ST); P3 (dolor torácico probablemente coronario con electrocardiograma (ECG) normal o no diagnóstico) y P4 (dolor torácico no coronario).La variable dependiente fue el género, y las independientes el tiempo puerta–ECG(t1) para cada protocolos; en P1 y P2 el lugar de ingreso del paciente; y en P3 los porcentajes de pacientes a los que se les hizo doble determinación de troponina y prueba de esfuerzo y los tiempos puerta-alta (t2) y puerta-prueba de esfuerzo (t3). En las variables en que se hallaron diferencias significativas, se estratificó por edad y TIMI. Resultados: Se visitaron 4.568 pacientes (5% P1, 8% P2, 46% P3, 41% P4). El 45%fueron mujeres, con una edad media de 74 ± 18 años (varones 58 ± 18 años ;p < 0,001) y un TIMI menor de 2 en el 63% de ellas (varones 47%; p < 0,001). El t1(mediana, en minutos) fue superior en las mujeres en todos los protocolos (P1: 7 vs 5,p = 0,06; P2: 12 vs 9, p = 0,15; P3: 15 vs 13, p < 0,01; P4: 21 vs 19, p = 0,25). Las mujeres ingresaron con menor frecuencia en las unidades de cuidados intensivos o intermedios(36% vs 62%, p < 0,001) y se les solicitaron menos pruebas de esfuerzo(33% vs 39%; p < 0,01). Al estratificar por edad, sólo se mantuvo significativo un menor porcentaje de ingresos en intensivos/intermedios en las mujeres entre 71 y 80 años y una menor cantidad de pruebas de esfuerzo en las mujeres entre 81-90 años. Al estratificar por TIMI, también desaparecieron gran parte de las diferencias y sólo se mantuvieron unos porcentajes inferiores de ingresos en intensivos/intermedios para las mujeres con TIMI <= 2 (15% vs 43%; p < 0,01) y de pruebas de esfuerzo en mujeres con TIMI entre 3 y 4 (23% vs 33%; p = 0,04).Conclusiones: La aproximación diagnóstica del dolor torácico en el SUH puede parecer menos intensa en las mujeres, pero muchas de las diferencias inicialmente observadas desaparecen al estratificar por la edad y el TIMI (AU)


Objective: To assess whether the diagnosis of chest pain is approached differently in men and women attending hospital emergency services. Method: Patients who were treated consecutively in the chest pain unit of a hospital emergency department over a period of 16 months were studied. After the preliminary examination and electrocardiogram (ECG), patient assessment followed 1 of 4 protocols: P1, acute coronary syndrome (ACS) with ST elevation; P2, ACS with ST depression; P3, chest pain with probable ACS but a normal or inconclusive ECG; and P4, chest pain unrelated to ACS. Gender was the dependent variable. The independent variables were time from arrival at the door of the emergency room until the first ECG (t1) for each protocol; the admitting department for P1 and P2 patients; and the percentage of patients in whomtroponin was measured twice and a stress test was ordered, door arrival to discharge time (t2), and door arrival to stress test time (t3) for P3 patients. Variables that were significantly different between genders were studied further with the population stratified by age and risk score for thrombosis in myocardial infarction (TIMI).Results: A total of 4568 patients were attended (5% P1, 8% P2, 46% P3, 41% P4). Forty-five percent were women. The mean (SD) ages were 74 (18) years for women and 58 (18) years for men (P<.001). Sixty-three percent of women and47% of men had a TIMI risk score less than 2 (P<.001). The median t1 was longer for women than men in all protocols(P1, 7 minutes vs 5 minutes, respectively, P=.06; P2, 12 vs 9 minutes, P=.15; P3, 15 vs 13 minutes, P<.01; P4, 21 vs 19minutes, P=.25). Women were admitted to intensive or intermediate care units less often than men (36% vs 62%,P<.001) and stress tests were less often ordered for them (33% vs 39%, P<.01). The only difference that remained after stratifying by age was a lower percentage of intensive or intermediate care unit admission for women between 71 and80 years of age and fewer stress tests for women between 81 and 90 years old. Many differences also disappeared after stratifying by TIMI risk score. Women with TIMI risk scores less than 2 were less often admitted to intensive or intermediate care units than men (15% vs 43%, P<.01); those with scores between 3 and 4 were less often scheduled for stress tests (23% vs 33%, P=.04).Conclusions: The diagnosis of chest pain in this hospital emergency department seems to be less energetically pursued in women; however, many of the differences initially observed disappear when the population is stratified by age and TIMI risk score (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Dor no Peito/diagnóstico , Emergências/epidemiologia , Identidade de Gênero , Cuidados Críticos/métodos , Prognóstico , Isquemia Miocárdica/complicações , Revascularização Miocárdica/métodos , Cuidados Críticos/tendências , Revascularização Miocárdica/instrumentação , Revascularização Miocárdica/tendências , Revascularização Miocárdica
6.
Pacing Clin Electrophysiol ; 28(7): 730-2, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16008813

RESUMO

We report a case of electrocardiographic signature of the Brugada syndrome in a 39-year-old patient with an overdose of diphenhydramine. He was found unconscious and hypotensive. His serum potassium concentration was 8.3 mEq/L and the ECG revealed a coved-type ST-segment elevation in leads V2-V3. These repolarization abnormalities neither normalize with the correction of the hyperkalemia nor with an intravenous infusion of isoproterenol. When he regained consciousness, he was admitted the toxic ingestion of diphenhydramine and progressively the ECG normalized. A negative flecainide test confirmed that the transient ECG abnormalities were the consequence of the drug overdose and ruled out the Brugada syndrome.


Assuntos
Difenidramina/envenenamento , Eletrocardiografia , Adulto , Morte Súbita Cardíaca/etiologia , Overdose de Drogas , Humanos , Masculino , Tentativa de Suicídio
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA