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Aproximación diagnóstica al dolor torácico en urgencias: ¿existen diferencias entre mujeres y hombres? / Diagnosis of chest pain in the emergency room: Is the approach different for men and women?
Emergencias (St. Vicenç dels Horts) ; 20(6): 399-404, nov.-dic. 2008. tab
Artigo em Espanhol | IBECS | ID: ibc-70069
Biblioteca responsável: ES15.1
Localização: ES15.1 - BNCS
RESUMEN

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)
ABSTRACT

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)
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Coleções: Bases de dados nacionais / Espanha Base de dados: IBECS Assunto principal: Prognóstico / Dor no Peito / Isquemia Miocárdica / Cuidados Críticos / Emergências / Identidade de Gênero / Revascularização Miocárdica Aspecto clínico: Diagnóstico / Etiologia / Prognóstico Limite: Feminino / Humanos / Masculino Idioma: Espanhol Revista: Emergencias (St. Vicenç dels Horts) Ano de publicação: 2008 Tipo de documento: Artigo Instituição/País de afiliação: Hospital Clínic/España