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1.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 9-18, feb. 2020. graf, tab
Artigo em Espanhol | IBECS | 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


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Análise de Dados , Ficha Clínica , Eletrocardiografia/estatística & dados numéricos , Dor no Peito/epidemiologia , Síndrome Coronariana Aguda/diagnóstico , Indicadores Básicos de Saúde , Razão de Chances , Modelos Logísticos , Análise Multivariada
2.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 377-384, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185134

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


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Dor no Peito/epidemiologia , Serviços Médicos de Emergência , Síndrome Coronariana Aguda/epidemiologia , Métodos Epidemiológicos , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Infarto do Miocárdio sem Supradesnível do Segmento ST , Infarto do Miocárdio com Supradesnível do Segmento ST , Estudos Retrospectivos , Fatores de Risco , Análise de Variância
3.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(10): 755-759, 2019 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-31594109

RESUMO

Objective: To analyze the clinical characteristics of pulmonary embolism patients from different altitudes in plateau areas. Methods: A retrospective cross-sectional study was used to analyze the patients with acute pulmonary embolism diagnosed definitely by pulmonary angiography or pulmonary artery CT angiography admitted to Tibet Autonomous Region People's Hospital from August 2014 to December 2018. The subjects were divided into 3 groups according to the altitude of long-term residence before onset, i.e. low-altitude group (group 1, 2 700 m ≤ altitude ≤3 700 m, n=44), medium-altitude group (group 2, 3 700 m

Assuntos
Altitude , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Dor no Peito/epidemiologia , China/epidemiologia , Angiografia por Tomografia Computadorizada , Estudos Transversais , Dispneia/epidemiologia , Humanos , Hipóxia , Incidência , Embolia Pulmonar/epidemiologia , Estudos Retrospectivos
4.
Ethiop J Health Sci ; 29(4): 439-446, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31447516

RESUMO

Background: Prodromal symptoms in individuals with risk factors remain challenging, even though myocardial infarction has been noted in research. This study determined the association of risk factors with patients' baseline myocardial infarction related prodromal symptoms. Methods: In a cross-sectional study, 154 Iranian men and women, mean age 59.62 ± 12.74 years were assessed in 2016-2017. The frequency besides severity of 33 prodromal symptoms and risk factors was assessed using McSweeney Prodromal Myocardial Infarction Symptom Survey. Results: The main cardiac prodromal symptoms experienced by patients were chest pain/discomfort (n = 99, 64.30%), unusual fatigue (n = 78, 50.60%), and sleep disturbance (n = 33, 20.40%). Women experienced more prodromal symptoms than men (33.26 ± 21.88 vs. 25.48 ± 17.75). Among risk factors, only sex was associated with prodromal symptoms score (P < 0.05). Conclusion: The frequently experienced prodromal symptoms, i.e., before MI were chest pain/discomfort, unusual fatigue, and sleep disturbance. A crucial finding was the significant association between sex and prodromal symptoms. Identifying prodromal symptoms in patients with risk factors can prevent the incidence of myocardial infarction.


Assuntos
Infarto do Miocárdio/epidemiologia , Sintomas Prodrômicos , Idoso , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Estudos Transversais , Fadiga/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Fatores de Risco , Fatores Sexuais , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia
5.
Scand J Trauma Resusc Emerg Med ; 27(1): 84, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464622

RESUMO

BACKGROUND: Chest pain is common in acute ambulance transports. This study aims to characterize and compare ambulance-transported chest pain patients to non-chest pain patients and evaluate if patient characteristics and accompanying symptoms accessible at the time of emergency call can predict cause and outcome in chest pain patients. METHODS: Retrospective, observational population-based study, including acute ambulance transports. Patient characteristics and symptoms are included in a multivariable risk model to identify characteristics, associated with being discharged without an acute cardiac diagnosis and surviving 30 days after chest pain event. RESULTS: In total, 10,033 of 61,088 (16.4%) acute ambulance transports were due to chest pain. In chest pain patients, 30-day mortality was 2.1% (95%CI 1.8-2.4) compared to 6.0% (95%CI 5.7-6.2) in non-chest pain patients. Of chest pain patients, 1054 (10.5%) were diagnosed with acute myocardial infarction, and 5068 (50.5%) were discharged without any diagnosis of disease. This no-diagnosis group had very low 30-day mortality, 0.4% (95%CI 0.2-0.9). Female gender, younger age, chronic pulmonary disease, absence of accompanying symptoms of dyspnoea, radiation, severe pain for > 5 min, clammy skin, uncomfortable, and nausea were associated with being discharged without an acute cardiac diagnosis and surviving 30 days after a chest pain event. CONCLUSION: Chest pain is a common reason for ambulance transport, but the majority of patients are discharged without a diagnosis and with a high survival rate. Early risk prediction seems to hold a potential for resource downgrading and thus cost-saving in selected chest pain patients.


Assuntos
Ambulâncias , Dor no Peito/epidemiologia , Adulto , Idoso , Dinamarca , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Prevalência , Estudos Retrospectivos , Taxa de Sobrevida
6.
N Z Med J ; 132(1495): 30-41, 2019 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-31095542

RESUMO

AIMS: Perform an audit which identifies the breadth and commonality of presenting complaints and diagnoses presenting to Middlemore Hospital over a one-week period in August 2016. METHODS: Two thousand and eleven patients attended Middlemore Hospital over one week in winter 2016, with 53 patients excluded. Information from the remaining 1,958 patient discharge summaries were obtained and made confidential for coding purposes. RESULTS: Of 1,958 patients, there were 78 different presenting complaints, with 444 individual final diagnoses. The five most common complaints were cough (n=158, 8.1%), chest pain (n=133, 6.8%), shortness of breath (n=92, 4.7%), finger pain (n=69, 3.5%) and collapse (n=59, 3.0%). Viral illness (n=84, 4.3%), pneumonia (n=83, 4.3%) and laceration/incised wound (n=75, 3.8%) were the three most common diagnoses. With hindsight, only 2 of the 25 most common diagnoses could be classified as severe conditions-often associated with high morbidity or mortality. CONCLUSIONS: Numerous patients are diagnosed with mild conditions after work-up in the emergency department, however a broad diagnostic approach is required by junior clinicians given the possibility of more worrying diagnoses. An analysis of specific markers used by junior clinicians to aid differential diagnosis shows that not all signs and symptoms are required to make common diagnoses. For example, the absence of a documented fever, raised CRP or both, does not rule out significant infection in the case of pneumonia, urinary tract infection and cellulitis. This audit contributes to understanding the case-mix within the emergency department at Middlemore Hospital and allows for tailoring of service delivery and education of junior clinicians.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Dor no Peito/epidemiologia , Criança , Pré-Escolar , Tosse/epidemiologia , Dispneia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Sumários de Alta do Paciente Hospitalar , Estudos Retrospectivos , Adulto Jovem
7.
J Surg Res ; 242: 336-341, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31129243

RESUMO

BACKGROUND: Individuals with sickle cell disease (SCD) are at high risk of developing life-threatening complications, particularly acute chest syndrome (ACS) postoperatively. The perioperative factors associated with the development of ACS in children with SCD after splenectomy have not been clearly identified. MATERIALS AND METHODS: We retrospectively reviewed medical records of all children who underwent splenectomy at our institution between 1997 and 2017 with the goal of identifying perioperative factors associated with postoperative ACS. Categorical and noncategorical variables were compared using Fisher's exact test and Student's two-tailed t-test, respectively. RESULTS: Sixty-five patients with SCD underwent splenectomy at a median of 4.0 (interquartile range [IQR] 2.0-8.0) years of age. A laparoscopic approach was used for 64 (98.5%) patients. Fifty-six (86.2%) underwent laparoscopic total splenectomy, and eight (12.3%) underwent laparoscopic partial splenectomy, of which two were converted to open. One had an open partial splenectomy (1.5%). Of the 65 patients, 10 (15.4%) developed ACS with a mean time to diagnosis of 49.0 ± 34.5 h. Children who developed ACS had a higher postoperative median pain score of 6.8 (IQR 5.1-9.1) versus 2.7 (IQR 1.6-4.2), P < 0.001, higher median pain score area under the curve 111.5 (IQR 76.9-169.1) versus 47.3 (IQR 30.5-78.3), P = 0.01, and received more total morphine equivalents (median 1.4 [IQR 0.4-2.7] versus 0.5 [IQR 0.3-0.9] mg/kg, respectively; P = 0.003), compared with children who did not develop ACS. CONCLUSIONS: Significant postoperative pain may be an early sign of ACS that could be worsened by opioid use, supporting the investigation of nonopioid pain control options in this patient population.


Assuntos
Síndrome Torácica Aguda/epidemiologia , Anemia Falciforme/cirurgia , Dor no Peito/epidemiologia , Dor Pós-Operatória/epidemiologia , Esplenectomia/efeitos adversos , Síndrome Torácica Aguda/diagnóstico , Síndrome Torácica Aguda/etiologia , Analgésicos Opioides/uso terapêutico , Anemia Falciforme/complicações , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Criança , Pré-Escolar , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Lactente , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação/estatística & dados numéricos , Masculino , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Fatores de Risco , Esplenectomia/métodos
8.
PLoS One ; 14(4): e0215719, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31017947

RESUMO

Chest pain (CP) is common, frightening, and often medically unexplained. Occupational psychological factors are associated with somatic pain. Personality may influence both perceived working conditions and somatic health, thereby confounding associations of work with health. Despite this, very few studies have investigated the interplay between work factors, personality and pain. The current study assessed relationships of a relatively novel work factor, human resource primacy (HRP), and a personality factor known to be relevant to health, dispositional optimism (Opt), with CP across two years (N = 6714). A series of structural equation models (SEMs) were fitted, modeling "substantive" and "confounded" relationships of psychological factors with CP. A "common latent factor" (CLF) was included to account for bias by unmeasured factors that may have influenced all variables (e.g. reporting bias) and the role of optimism as a possible confounder of the relationship between HRP and CP was investigated specifically. Independent effects of HRP and Opt on CP were observed. No effects of HRP/CP on Opt were observed. Opt appeared to confound the relationship between HRP and CP to some extent. However, best fit was observed for a "reciprocal" model with independent lagged effects from HRP/Opt to CP as well as from CP/Opt to HRP. Thus, results suggested a mutual causal dynamic between HRP and CP along with an influence of Opt on both HRP and CP-implying that working conditions influence the experience of chest pain while the chest pain also influences the experience of working conditions. Optimistic dispositions may influence the experience of both work and pain, but not to an extent that fully explains their relationship. Hence, the notion that associations of HRP with CP are mere artifacts of optimistic/pessimistic reporting was not supported. More likely, complex reciprocal relationships exist between these factors, in which mutual reinforcements occur and both vicious and virtuous cycles may result.


Assuntos
Dor no Peito/psicologia , Otimismo/psicologia , Recursos Humanos , Adulto , Idoso , Dor no Peito/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Noruega/epidemiologia , Saúde do Trabalhador , Personalidade , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
9.
Rev Esp Cardiol (Engl Ed) ; 72(10): 813-819, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30971378

RESUMO

INTRODUCTION AND OBJECTIVES: To analyze differences between sexes in the clinical management of patients presenting with symptoms of chest pain and/or palpitations within a population-based study. METHODS: The OFRECE study included a random sample of 8400 individuals from the Spanish population aged 40 years and older; 1132 (13.5%) had previously consulted for chest pain and 1267 (15.1%) had consulted for palpitations and were included in the present study. We calculated both the crude and adjusted odds ratios (OR) of undergoing certain tests and the results of consultations by sex. Adjustment was performed by classic cardiovascular risk factors, a personal history of cardiovascular disease, and a diagnosis of stable angina or atrial fibrillation confirmed in the OFRECE study in each case. RESULTS: No differences were observed in history of consultation for chest pain between women and men (13% vs 14.1%; P=.159) but differences were found in palpitations (19% vs 10.4%, respectively; P <.001). Women who had previously consulted for chest pain underwent fewer echocardiograms (32.5% vs 45.3%, respectively; P <.001), were less frequently referred to a cardiologist (49.1% vs 60.1%; P <.001), were less often admitted to hospital (20.1% vs 39.4%; P <.001), and less frequently received a confirmed diagnosis (60.9 vs 71, 9; P <.001). After full adjustment, all differences decreased and become nonsignificant echocardiograms: adjusted OR, 0.81; 95%CI, 0.60-1.09; referral to a cardiologist: adjusted OR, 0.86; 95%CI, 0.63-1.16; hospital admission: adjusted OR, 0.76; 95%CI, 0.54-1.09). For palpitations, crude differences were smaller and all became nonsignificant after adjustment. CONCLUSIONS: This study does not confirm the existence of sex-related bias in the management of chest pain and palpitations. However, such bias cannot be completely ruled out in diagnoses confirmed within the OFRECE study, which might limit its ability to detect sex-related differences in health care.


Assuntos
Fibrilação Atrial/diagnóstico , Dor no Peito/diagnóstico , Ecocardiografia/métodos , Serviço Hospitalar de Emergência , Encaminhamento e Consulta , Medição de Risco/métodos , Adulto , Idoso , Fibrilação Atrial/epidemiologia , Dor no Peito/epidemiologia , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Fatores Sexuais , Espanha/epidemiologia
10.
Can J Cardiol ; 35(4): 438-445, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30935634

RESUMO

BACKGROUND: This study describes the different types of congenital vascular rings according to their anatomy, symptoms, and age at clinical onset and reports the surgical outcomes. METHODS: A retrospective observational database study was conducted, reviewing the medical charts of 69 adult survivors with a history of a vascular ring, identified from the Dutch Congenital Cor vitia database. RESULTS: Median age at presentation was 8.5 years (0-53.0 years). Thirty patients (43.5%) had a "left aortic arch with aberrant right subclavian artery," 21 patients (30.4%) a "double aortic arch," and 16 patients (23.2%) a "right aortic arch with aberrant left subclavian artery." The main symptomatology at presentation comprised respiratory symptoms (82.9%). Almost three-quarters of patients were also diagnosed with asthma/bronchial hyperreactivity. Patients with a double aortic arch had more symptoms than patients with a left aortic arch with aberrant right subclavian artery and right aortic arch with aberrant left subclavian artery (P < 0.001), requiring surgery most often (P < 0.001). In patients with childhood onset of symptoms, preoperative spirometry (ie, peak expiratory flows) was more often abnormal as compared with adult patients (P = 0.007). Surgery was performed in 42.0% of all patients at a median age of 17 years (0-63.0 years). Twenty-four (92.3%) of the operated patients showed improvement or complete relief of symptoms shortly after surgery. Of 26 asymptomatic nonoperated patients, 3 patients (11.5%) eventually developed symptoms. CONCLUSIONS: The low incidence of vascular rings, their anatomic heterogeneity, and a wide range of common symptoms often lead to misdiagnosis. Clinical awareness is warranted as a large subset of patients could benefit from surgery, even at an adult age.


Assuntos
Aorta Torácica/anormalidades , Artéria Subclávia/anormalidades , Sobreviventes , Anel Vascular/epidemiologia , Adolescente , Adulto , Idoso , Asma/epidemiologia , Hiper-Reatividade Brônquica/epidemiologia , Procedimentos Cirúrgicos Cardiovasculares/estatística & dados numéricos , Dor no Peito/epidemiologia , Criança , Pré-Escolar , Cianose/epidemiologia , Transtornos de Deglutição/epidemiologia , Dispneia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Sons Respiratórios , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Espirometria , Anel Vascular/cirurgia , Adulto Jovem
11.
Can J Gastroenterol Hepatol ; 2019: 5036160, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30941328

RESUMO

Background: Jackhammer esophagus is a hypercontractile esophageal disorder recently brought to light with the advent of high resolution manometry (HRM). As little is known about its clinical presentation, the aim of this study was to identify the clinical characteristics associated with this new gastrointestinal motility disorder. Methods: A retrospective study was conducted on patients visiting the CHUM's Gastro-Intestinal Motility Center from January 2015 to December 2017. The HRM diagnoses were collated in a database along with age and sex of every individual. The latest Chicago classification (version 3.0) was used. Among all the patients subjected to HRM, those diagnosed with Jackhammer esophagus were included in the study. Patient charts were reviewed to collect relevant demographic and clinical data. Key Results: A total of 36 patients with Jackhammer esophagus were included (62 ± 13 years age, 89% females). Their main symptoms were dysphagia (72%), pyrosis (42%), retrosternal chest pain (36%), and epigastralgia (33%). Other manometric findings were hypertonia (22%) and/or inadequate relaxation (19%) of the lower esophageal sphincter. Among the 26 patients who had esogastroduodenoscopy, hiatal hernia was seen in 3 patients. Pathological gastroesophageal reflux was found in 4 of the 10 patients investigated by pH-monitoring. Conclusions and Inferences: Jackhammer esophagus represents 3% of the HRM diagnoses in this study, with a significant female preponderance. In more than two-thirds of cases, the clinical presentation of Jackhammer esophagus is dysphagia.


Assuntos
Transtornos de Deglutição/epidemiologia , Transtornos da Motilidade Esofágica/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Manometria/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Transtornos de Deglutição/etiologia , Endoscopia do Sistema Digestório/métodos , Transtornos da Motilidade Esofágica/epidemiologia , Transtornos da Motilidade Esofágica/fisiopatologia , Monitoramento do pH Esofágico/métodos , Feminino , Refluxo Gastroesofágico/etiologia , Azia/epidemiologia , Azia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
12.
Recenti Prog Med ; 110(2): 93-97, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30843535

RESUMO

Background: Natural history and outcomes of patients with pulmonary embolism (PE) without typical symptoms (atypical PE) remain unclear. The aim of the study is to compare the clinical characteristics and the prognosis between typical PE and atypical PE. Methods: We retrospectively analyzed data from consecutive patients admitted to the Emergency Department (ED) because of a diagnosis of PE and classified them in two groups: typical PE and atypical PE. We defined PE to be typical in presence of almost one of the following symptoms or signs: dyspnea, chest pain, hemoptysis or signs of deep vein thrombosis. Results: Of the 191 patients with PE, 154 (81%) had typical PE and 37 (19%) had atypical PE. Patients with atypical and typical PE seemed to had similar prognostic factor such as high risk sPESI (73% vs 65%, p=0.3), right ventricular dysfunction (30% vs 26%, p=0.6) and central PE at chest CT scan (38% vs 36%, p=0.8). The rate of 30 day mortality was 7% in the typical group and 8% in the atypical group (p=0.8). The length of stay in hospital was the same in the two groups (6 days; p=0.2). Conclusions: We found that atypical and typical PE seem to be related diseases with a similar short term prognosis. Therefore, we could speculate that a missed diagnosis of PE in ED could expose the patients to a worsen prognosis. Further perspective studies are required for better investigate this diagnostic challenge.


Assuntos
Dor no Peito/epidemiologia , Dispneia/epidemiologia , Hemoptise/epidemiologia , Embolia Pulmonar/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor no Peito/etiologia , Dispneia/etiologia , Serviço Hospitalar de Emergência , Feminino , Hemoptise/etiologia , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Embolia Pulmonar/fisiopatologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Disfunção Ventricular Direita/epidemiologia , Adulto Jovem
13.
Am J Cardiol ; 123(8): 1343-1350, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30709600

RESUMO

Chest pain is a common reason for admission to hospital and little is known regarding 30-day unplanned readmissions after an admission with a primary discharge diagnosis of nonspecific chest pain. We analyzed patients with a primary diagnosis of nonspecific chest pain in the Nationwide Readmission Database who were admitted in 2010 to 2014. Rates, causes, and predictors of 30-day unplanned readmissions were determined. A total of 1,842,270 patients had a diagnosis of nonspecific chest pain. The 30-day unplanned readmission rate was 8.6%. From 2010 to 2014, there was an increase in 30-day unplanned readmissions from 8.1% to 9.5%. The majority of 30-day unplanned readmissions were for noncardiac reasons (73.4%). The 3 most prevalent noncardiac causes for readmissions were neuropsychiatric (10.9%), gastrointestinal (10.5%), and infections (9.9%), while the 3 most prevalent cardiac causes were coronary artery disease including angina (8.4%), arrhythmias (6.6%), and heart failure 5.5%. The strongest predictors of readmission were alcohol misuse ([OR] odds ratio 1.74 95% [CI] confidence interval 1.66-1.81), renal failure (OR 1.82 95%CI 1.76-1.87), cancer (OR 2.40 95%CI 2.27-2.53), discharge to a nursing home (OR 2.26 95%CI 2.18-2.34), and discharge against medical advice (OR 1.94 95%CI 1.86-2.02). The rate of 30-day unplanned readmission was 6.1% among those who received any test compared to 9.3% in those who did not receive any test. Rates of early unplanned readmissions occur following 1 in 12 admissions for nonspecific chest pain with noncardiac causes being the most common reason. Patients who receive a cardiovascular investigation appear to have fewer unplanned readmissions.


Assuntos
Dor no Peito/epidemiologia , Readmissão do Paciente/tendências , Sistema de Registros , Dor no Peito/diagnóstico , Dor no Peito/terapia , Angiografia Coronária , Bases de Dados Factuais , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Estados Unidos/epidemiologia
15.
Crit Pathw Cardiol ; 18(1): 19-22, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30747761

RESUMO

BACKGROUND: Although some emergency department observation units (EDOUs) may exclude patients over 65 years old, our EDOU accepts patients up to 79 years old. We assessed the utilization of our EDOU by older patients (those 65-79 years old). METHODS: We prospectively enrolled emergency department (ED) patients with chest pain. We gathered baseline data at the time of ED presentation and tracked outcomes related to the ED stay, EDOU, and/or inpatient admission. Our primary outcome included EDOU placement among older patients. Our secondary outcome was the rate of major adverse cardiac events [MACE: myocardial infarction, stent, coronary artery bypass graft, and death]. RESULTS: Over the 5-year study period, we evaluated 2242 ED patients with chest pain, of whom 19.4% (95% confidence interval, 17.8%-21.1%) were 65-79 years old. Older patients were more likely to be placed in the EDOU after the ED visit (45.8% vs. 36.6%; P = 0.001) and more likely to be admitted to an inpatient unit from the ED (31.8% vs. 17.9%;P < 0.001) than those under 65 years old. The overall MACE rate was similar between admitted older patients and those in the EDOU: 5.9% versus 4.3% (P = 0.57). Of the admitted older patients, 30.4% (95% confidence interval, 22.3%-39.9%) were low risk and there were no cases of MACE in this group. CONCLUSIONS: In an EDOU that allows older patients, we noted substantial utilization by these patients for the evaluation of chest pain. The characteristics of admitted older patients suggest the potential for even greater EDOU utilization in this group.


Assuntos
Dor no Peito/diagnóstico , Unidades de Observação Clínica/estatística & dados numéricos , Serviço Hospitalar de Emergência , Pacientes Internados , Infarto do Miocárdio/diagnóstico , Medição de Risco/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Feminino , Seguimentos , Humanos , Incidência , Masculino , Infarto do Miocárdio/complicações , Infarto do Miocárdio/epidemiologia , Estudos Prospectivos , Fatores de Tempo , Troponina/sangue , Utah/epidemiologia
16.
Crit Pathw Cardiol ; 18(1): 32-39, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30747763

RESUMO

BACKGROUND: The aim of this study was to evaluate whether pretest probability (PTP) assessment using the Diamond-Forrester Model (DFM) combined with coronary calcium scoring (CCS) can safely rule out obstructive coronary artery disease (CAD) and 30-day major adverse cardiovascular events (MACE) in acute chest pain patients. METHODS: We retrospectively evaluated consecutive patients, age ≥18 years, with no known CAD, negative initial electrocardiogram, and troponin level. All patients had coronary computed tomographic angiography (CCTA) with CCS, and our final cohort consisted of 1988 patients. Obstructive CAD was defined as luminal narrowing of ≥50% in 1 or more vessels by CCTA. Patients were classified according to PTP as low (<10%), intermediate (10%-90%), or high (>90%). RESULTS: The DFM classified 293 (14.7%), 1445 (72.7%), and 250 (12.6%) of patients as low, intermediate, and high risk, respectively, with corresponding 30-day MACE rates of 0.0%, 2.35%, and 14.8%. For patients with intermediate PTP and CCS ≤10, the negative predictive value was 99.2% (95% confidence interval: 98.7-99.8) for 30-day MACE while it was 92.62% (95% confidence interval: 87.9-97.3) for patients with high PTP. Among patients with a high PTP and CCS of zero, the prevalence of 30-day MACE and obstructive CAD remained high (7.07% and 10.1%, respectively). CONCLUSIONS: In acute chest pain patients without evidence of ischemia on initial electrocardiogram and cardiac troponin, low PTP by DFM or the combination of intermediate PTP and CCS ≤10 had excellent negative predictive values to rule out 30-day MACE. CCS is not sufficient to exclude obstructive CAD and 30-day MACE in patients with high PTP.


Assuntos
Cálcio/metabolismo , Dor no Peito/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Oclusão Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Calcificação Vascular/diagnóstico , Doença Aguda , Causas de Morte/tendências , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Oclusão Coronária/complicações , Eletrocardiografia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Estados Unidos/epidemiologia , Calcificação Vascular/complicações , Calcificação Vascular/metabolismo
17.
Scand Cardiovasc J ; 53(1): 28-34, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30760035

RESUMO

OBJECTIVES: Chest pain is one of the most frequent chief complaints in patients admitted to the emergency department (ED). No study has evaluated this patient population in Norway. The aim of the present study was to describe the diagnoses and logistics of chest pain patients admitted to the ED at a Norwegian university hospital. DESIGN: Data were collected from all patients referred to the ED at St. Olav's Hospital-Trondheim University Hospital in 2015. Patients presenting at the ED with a chief complaint of chest pain based on the Rapid Emergency Triage and Treatment System were included in this study. RESULTS: In the study period, 22,403 patients were admitted to the ED. Chest pain was the second most common chief complaint (11%), only exceeded by acute abdominal pain (18%). Among the chest pain patients, 12% had acute coronary syndrome (ACS) and 37% were diagnosed with non-specific chest pain. Gastrointestinal, musculoskeletal, and pulmonary conditions were less common, affecting 6%, 4%, and 4% of the patients, respectively. In total, 90% of the ED chest pain patients were handled by the Clinic of Cardiology. CONCLUSIONS: Chest pain was the second most common chief complaint among patients admitted to the ED, and most patients were handled by the Clinic of Cardiology. More than one-third of the patients received a cardiac diagnosis, but the largest group of patients was discharged with a diagnosis of non-specific chest pain. Other conditions managed by non-cardiac medical specialties were less common.


Assuntos
Angina Pectoris/diagnóstico , Serviço Hospitalar de Cardiologia , Dor no Peito/diagnóstico , Serviço Hospitalar de Emergência , Adulto , Idoso , Idoso de 80 Anos ou mais , Angina Pectoris/epidemiologia , Angina Pectoris/terapia , Dor no Peito/epidemiologia , Dor no Peito/terapia , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Admissão do Paciente , Prognóstico , Triagem
18.
Med J Aust ; 210(7): 321-325, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30773636

RESUMO

OBJECTIVES: To compare the outcomes and safety of a rapid access chest pain clinic (RACPC) in Australia with those of a general cardiology clinic. DESIGN: Prospective comparison of the outcomes for patients attending an RACPC and those of historical controls. SETTING: Royal Hobart Hospital cardiology outpatient department. PARTICIPANTS: 1914 patients referred for outpatient evaluation of new onset chest pain (1479 patients seen in the RACPC, 435 patients previously seen in the general cardiology clinic). MAIN OUTCOME MEASURES: Service outcomes (review times, number of clinic reviews); adverse events (unplanned emergency department re-attendances at 30 days and 12 months; major adverse cardiovascular events at 12 months, including unplanned revascularisation, acute coronary syndrome, stroke, cardiac death). RESULTS: Median time to review was shorter for RACPC than for usual care patients (12 days [IQR, 8-15 days] v 45 days [IQR, 27-89 days]). All patients seen in the RACPC received a diagnosis at the first clinic visit, but only 139 patients in the usual care group (32.0%). There were fewer unplanned emergency department re-attendances for patients in the RACPC group at 30 days (1.6% v 4.4%) and 12 months (5.7% v 12.9%) than in the control group. Major adverse cardiovascular events were less frequent among patients evaluated in the RACPC (0.2% v 1.4%). CONCLUSIONS: Patients were evaluated more efficiently in the RACPC than in a traditional cardiology clinic, and their subsequent rates of emergency department re-attendances and adverse cardiovascular events were lower.


Assuntos
Serviço Hospitalar de Cardiologia/estatística & dados numéricos , Dor no Peito/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Ambulatório Hospitalar/estatística & dados numéricos , Clínicas de Dor/estatística & dados numéricos , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Dor no Peito/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Encaminhamento e Consulta , Fatores de Tempo , Vitória/epidemiologia
19.
Semergen ; 45(1): 23-29, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-30268361

RESUMO

OBJECTIVES: 1) To determine the prevalence of intimate partner violence (IPV) in patients seen in the emergency department with chest pain. 2)To analyse the possible association between IPV and presence/control of vascular risk factors (VRF), psychic manifestations of stress, delay in requesting care, care received, and prognosis. METHODS: The study was conducted on 125 women, and included a targeted interview, the Partner Violence Screen (PVS) test, a 30-day follow-up telephone interview, and a one-year follow-up clinical history review. RESULTS: A total of 27 patients (21.6%) had a history of IPV, which was present in 4 of them. Women with a history of IPV were younger (53.7±15.0 vs. 64.0±18.4; P=.020), had more anxiety or a depressive syndrome (57.7% vs 13.5%; P<0.001), and consulted later (35.0±65.2days vs 7.9±25.0days; P=.047). Among older women (≥65years), there was more dyslipidaemia (100% vs 60.4%; P=.039) and worse blood pressure control (good control 20% vs 78.4%; P=.007) in those with a history of IPV. There were no differences in the diagnoses, tests, length of stay, admissions or prognosis among patients with or without a history of IPV, and there were no differences according to chronology of IPV. CONCLUSIONS: The current or previous existence of IPV in patients who consult for chest pain in the emergency department is high. The existence of IPV is associated with a delay in consultation and greater anxiety, and may contribute to poor control of VRF, but does not affect the prognosis in the medium term.


Assuntos
Dor no Peito/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Violência por Parceiro Íntimo/estatística & dados numéricos , Programas de Rastreamento/métodos , Adulto , Fatores Etários , Idoso , Feminino , Seguimentos , Humanos , Entrevistas como Assunto , Tempo de Internação , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prevalência , Prognóstico , Fatores de Risco , Parceiros Sexuais , Fatores de Tempo
20.
Int J Cardiol ; 280: 19-28, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30292436

RESUMO

Patients presenting with chest pain suggestive of coronary artery disease (CAD) who at coronary arteriography appear to be free of obstructive disease have presented a diagnostic and therapeutic challenge since the 1970's. Studies in female patient populations have suggested that this is predominantly a women's syndrome usually caused by microvascular endothelial dependent and independent dysfunction. A critical review of the literature focusing on studies including both women and men revealed that apart from a higher incidence of this syndrome in women there are no clinical relevant differences between both sexes. In women a lower coronary flow reserve has been reported but this appears to be mainly due to a higher basal flow. Important questions with regard to the clinical implications of microvascular dysfunction have yet to be resolved in studies involving women as well as men in which a distinction is made between patients with normal coronary arteries and those with nonobstructive disease.


Assuntos
Dor no Peito/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Microcirculação/fisiologia , Dor no Peito/epidemiologia , Dor no Peito/fisiopatologia , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Fatores Sexuais
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