Emergency medicine
Majid Zamani; Maliheh Mazaheri; Farhad Heydari; Babak Masoumi
Volume 7, Issue 1 , January 2021, , Pages 17-21
Abstract
Objective: Ultrasonography (US) is not the method of choice for the diagnosis of calcaneal fractures. The aim of this study was to compare the diagnostic accuracy of US with plain radiography in the diagnosis of calcaneus fractures following blunt ankle and foot trauma. Methods: In this cross-sectional ...
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Objective: Ultrasonography (US) is not the method of choice for the diagnosis of calcaneal fractures. The aim of this study was to compare the diagnostic accuracy of US with plain radiography in the diagnosis of calcaneus fractures following blunt ankle and foot trauma. Methods: In this cross-sectional study, 214 patients (over 18 years) presenting to the emergency department (ED) with suspicion of traumatic calcaneus fracture following acute blunt trauma, were enrolled. Bedside ultrasonography was performed and interpreted by emergency physicians. After that, plain radiography was performed. Furthermore, all the patients were assessed by computed tomography (CT) scan as the gold standard. Results: Finally, 193 patients were enrolled with a mean age of 29.4±15.7 years (85.5% male). Fractures in the calcaneus were detected in 49 patients. The sensitivity and specificity of ultrasonography in the detection of calcaneal fractures were 83.6%, (confidence interval (CI), 69.7 –92.2) and 100% (95% CI, 96.7 –100), while the sensitivity and specificity of X-ray were 87.7% (95% CI, 74.5 –94.9) and 100% (95% CI, 96.7 –100). There was no false positive result for X-ray and US. Conclusion: Our findings suggest that bedside US with an acceptable sensitivity and specificity can be used as a promising alternative for the diagnosis of calcaneal fracture in ED.
Emergency medicine
Mulla Mahammad Rafi; Mohammed Ismai Nizami; Uppaluri Sarath Chandra; Ashima Sharma; Gaddam Dharani Reddy; Lubna Tarannum
Volume 7, Issue 1 , January 2021, , Pages 36-40
Abstract
Objective: COVID-19 has become a major public health concern in recent times with detrimental effects on health and economy of the nation exerting unbearable pressure on health care personnel. It is vital for the caretakers and the people accompanying those patients to be aware of the ongoing pandemic ...
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Objective: COVID-19 has become a major public health concern in recent times with detrimental effects on health and economy of the nation exerting unbearable pressure on health care personnel. It is vital for the caretakers and the people accompanying those patients to be aware of the ongoing pandemic and its impact on the society and to realize their responsibility towards curbing the spread of the disease. The aim of this study is to assess the awareness of COVID-19 among the attendants accompanying the patients at emergency department (ED) and to determine their perception of the disease. Methods: A questionnaire was prepared and the attendants were approached with it. The attendants responded to the questionnaire by choosing the appropriate answers. Illiterates were explained about the questions in the language they understood and the responses were recorded. The survey was conducted from May 25th, 2020 to June 10th, 2020. Descriptive analysis was done to represent the study characters. Results: A total of 509 participants responded to the questionnaire with the mean age between 30 to 50 years. Participants were fairly conversant of the preventive measures but a significant portion lacked the knowledge of transmission and the impact of COVID-19. Education was observed to have a positive correlation with the correct responses given. Conclusion: Public education for the spread of awareness is yet to reach the illiterate section of the society. The need exists for educating the attendants of the patients as well who actually are potential candidates for contracting and also for spreading the disease
Emergency medicine
Seyed Reza Habibzadeh; Esmaeil Rayat Dost; Saeed Barazandehpour; Mahdi Foroughian
Volume 7, Issue 1 , January 2021, , Pages 69-70
Abstract
Introduction: Unilateral and bilateral tongue cyanosis usually occurs due to the Raynaud syndrome and in the underlying severe types of vasculitis and rheumatology.Case Presentation: The present study was conducted on a 54-year-old woman who referred to the emergency department with complaints of ...
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Introduction: Unilateral and bilateral tongue cyanosis usually occurs due to the Raynaud syndrome and in the underlying severe types of vasculitis and rheumatology.Case Presentation: The present study was conducted on a 54-year-old woman who referred to the emergency department with complaints of sudden and painless discoloration of the left half of the tongue. The patient had no history of disease other than diabetes controlled with glibenclamide. Clinical examination of the head and neck revealed evidence of unilateral cyanosis in the left half of the tongue without pain, whose discoloration did not improve with warming of the tongue.Conclusion: Cyanosis in the emergency department can be managed appropriately by considering some parameters including history taking, history of cyanosis occurrence, history of cardiopulmonary disease, cold sensitivity and history of rheumatologic diseases, presence or absence of nail clubbing, arterial blood oxygen saturation and arterial blood gas test results. These parameters can be effective in designing a treatment regimen, while differentiating the causes of central from peripheral cyanosis.
Infectious disease
Sohil Pothiawala
Volume 6, Issue 2 , July 2020, , Pages 102-108
Abstract
Introduction: Emerging viral diseases (EVDs) pose a significant threat to public health. There have been a few viral epidemics in the last two decades. Coronavirus disease 2019 (COVID-19) is now a global pandemic.Objective: To provide emergency physicians an update on severe acute respiratory syndrome ...
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Introduction: Emerging viral diseases (EVDs) pose a significant threat to public health. There have been a few viral epidemics in the last two decades. Coronavirus disease 2019 (COVID-19) is now a global pandemic.Objective: To provide emergency physicians an update on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its dynamic impact on the emergency department (ED) in terms of preparedness and management of patients presenting to ED with suspected COVID-19 disease.Discussion: COVID-19 has a human-to-human transmission through close contact and even from asymptomatic carriers. Symptoms are similar to a viral respiratory illness. The disease is mild and self-limiting in most patients, but some develop severe illness like pneumonia, acute respiratory distress syndrome (ARDS) and multiorgan failure. Emergency physicians should prioritize early identification of these patients at risk, isolate them and after collaborating with relevant hospital and national authorities, develop clinical pathways to safely evaluate, manage and dispose patients with COVID-19. Various strategies for managing these patients in the ED are discussed. Disposition of these patients depends on symptoms and hemodynamic status and potential to self quarantine versus admission to an isolation facility.Conclusion: This review provides an overview of patients presenting to the ED with suspected COVID-19 and its impact on the ED. It reiterates the fact that emergency physicians, in close collaboration with relevant hospital authorities, play a pivotal role during EVDs. It emphasizes the need for pandemic preparedness, enabling us to better manage such events in the future.
Clinical Toxicology
Luis Rafael Moscote-Salazar; Guru Dutta Satyarthee; Nidia Escobar Hernandez; Jorge Aquino Matus; Willem Guillermo Calderon-Miranda; Marco Antonio Blancas-Varas; Johana Maraby; Joulen Mo-Carrascal
Volume 4, Issue 2 , July 2018, , Pages 53-54
Abstract
Scuba diving is associated with an important risk of developing decompression sickness secondary to formation of gas bubbles inside the body. The latter is formed mainly by nitrogen in the body on the diver’s way to the surface (1,2). In some cases, it might injure the central nervous system. ...
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Scuba diving is associated with an important risk of developing decompression sickness secondary to formation of gas bubbles inside the body. The latter is formed mainly by nitrogen in the body on the diver’s way to the surface (1,2). In some cases, it might injure the central nervous system. Several decompression cases that have been associated with neurologic symptoms are described in the literature; however, brain multi-infarct with lethal outcome has never been described.
Emergency medicine
Hammoda Abu-Odah; Akram Abu Salah; Ali El-Khateeb; Khawla El-Nems
Volume 4, Issue 2 , July 2018, , Pages 77-81
Abstract
Objective: Patients’ satisfaction (PS) is recognized as an important emergency department service design and it has received a high interest and attention in the health management where many studies have focused on determining factors affecting PS in health-related circumstances. In this study, ...
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Objective: Patients’ satisfaction (PS) is recognized as an important emergency department service design and it has received a high interest and attention in the health management where many studies have focused on determining factors affecting PS in health-related circumstances. In this study, we aimed to examine PS in emergency department (ED) of the European Gaza Hospital (EGH) in the Gaza Strip (GS).Methods: A descriptive-analytical cross sectional study was performed at ED-EGH between March, 15 and June 20, 2015. Press Ganey questionnaire was used as a tool for data collection. For each patient, a self-administered questionnaire including 22 questions was filled based on a Likert scale. Results were analyzed using SPSS version 22.Results: Overall, 200 respondents were included in the study. About 73% of respondents were satisfied with overall medical services. The term of nurses’ concern provided to patients elicited the highest score (83.1%), followed by physicians’ concern with patients (72.0%) and communication skills with patients (71.4%), while the lowest score was reported in waiting time and security staff. Furthermore, our findings show an association between PS and level of education, gender differences, living area, and work shifts.Conclusion: The study results conclude that areas of medical and nursing care, respects of staff, physical comfort and waiting time ED-EGH is highly acceptable and offer in appropriate manners.
Emergency medicine
Krishna Prasad; Susan Tharian; Jebu A Thomas
Volume 4, Issue 2 , July 2018, , Pages 89-91
Abstract
Traumatic spinal epidural hematoma (TSEH) is a neurosurgical emergency which is considered as one of the rare causes of back pain. The onset of symptoms presentation can vary especially following a trauma. Here, we report a case where a young girl had a trivial fall and presented symptoms of back pain ...
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Traumatic spinal epidural hematoma (TSEH) is a neurosurgical emergency which is considered as one of the rare causes of back pain. The onset of symptoms presentation can vary especially following a trauma. Here, we report a case where a young girl had a trivial fall and presented symptoms of back pain three days later. She developed abrupt onset of lower limb weakness during her stay in the emergency department (ED). X-ray and computed tomography (CT) imaging of the spine did not show any obvious abnormality whereas, Magnetic resonance imaging (MRI) imaging revealed hyper-intense lesions in the thoracic spinal segment which led to the diagnosis of TSEH. Our case highlights the importance of the atypical and varied nature of presentation and the choice of investigation which would help in the early diagnosis of this entity.
Emergency Medical Services
Somaye Younesian; Reza Shirvani; Ali Tabatabaey
Volume 4, Issue 1 , January 2018, , Pages 3-8
Abstract
Objective: Patient satisfaction (PS) is a major quality assessment index for the emergency department (ED) which affects patient safety, litigation, reimbursements, and consumer satisfaction. In this study we aimed to recognize the factors affecting PS in our center. Method: Random shifts during a week ...
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Objective: Patient satisfaction (PS) is a major quality assessment index for the emergency department (ED) which affects patient safety, litigation, reimbursements, and consumer satisfaction. In this study we aimed to recognize the factors affecting PS in our center. Method: Random shifts during a week were selected and all patients disposed from the ED were asked to fill out a revised and validated Persian version of the Press-Ganey questionnaire with the help of a research assistant. Results were analyzed using a linear regression model by SPSS software version 21. Results: Findings reaffirmed some of the factors previously described. These included longer door to treatment area times having a negative effect on satisfaction (P < 0.001), and providing vivid discharge information improving PS (P < 0.001). Other important factors were also found that had not previously been focused on, namely cleanliness of the area (P < 0.0001) and courtesy of the staff in charge of patient transfer (P = 0.03). We also found that men had a more satisfying ED experience (P = 0.002). Conclusion: Cultural expectations may have an important effect on PS. Thus, every institution should determine and alter the expectations most relevant to them.
emergency nursing
Farzad Rahmani; Pegah Sepehri Majd; Haniyeh Ebrahimi Bakhtavar; Farnaz Rahmani
Volume 4, Issue 1 , January 2018, , Pages 9-13
Abstract
Objective: Triage refers to the evaluation and categorization of patients for better management to deliver services. A good triage system should be able to accurately specify the patients who require urgent care. Thus, this study aimed to evaluate the accuracy of emergency nurses in correct triage ...
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Objective: Triage refers to the evaluation and categorization of patients for better management to deliver services. A good triage system should be able to accurately specify the patients who require urgent care. Thus, this study aimed to evaluate the accuracy of emergency nurses in correct triage using Emergency Severity Index (ESI) triage. Methods: In this descriptive cross-sectional study 750 patients, who referred to the emergency department (ED) of Sina teaching hospital, participated from 23 July to 22 August in 2015. Participants were selected using convenience sampling method. The patients’ triage level was determined by physicians and nurses separately and the results were compared. To define the level of agreement between two groups (inter-rater agreement), the kappa index was evaluated. Data were analyzed using SPSS version 17. Results: Among 750 patients, 577 patients (76.9%) were classified in correct triage group, 90 patients (12%) in undertriage group and 83 patients (11.1%) in overtriage group. Kappa agreement coefficient between the ESI triage level of physicians and nurses was 0.659 (95% CI: 0.646-0.667). There was statistically significant difference between the triage level of physicians and nurses (P < 0.001). Conclusion: This study showed that there was moderate agreement between the triages of physicians and nurses. It seems that improving nurses’ skills and knowledge might increase the accuracy of emergency nurses in patients’ correct triage. Therefore, planning programs based on training correct triage for emergency nurses is strongly suggested.
Emergency medicine
Seyed Hossein Ojaghi Haghighi; Samad Shams Vahdati; Tarannom Mahmoudie; Pegah Sepehri Majd; Mohammad Mirza-Aghazadeh-Attari
Volume 3, Issue 2 , July 2017, , Pages 49-52
Abstract
Objective: Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in the prevention of death or delaying it in a person with cardiac arrest. In this regard, demographic information about patients who need CPR is vital. Methods: In this cross-sectional study patients with cardiopulmonary ...
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Objective: Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in the prevention of death or delaying it in a person with cardiac arrest. In this regard, demographic information about patients who need CPR is vital. Methods: In this cross-sectional study patients with cardiopulmonary arrest or arrhythmias admitted to Imam Reza and Sina educational hospitals of Tabriz University of Medical Sciences from 22 December 2013 to 21 December 2014 entered the study. Demographic information such as age, sex, cardiopulmonary resuscitation time, the place of cardiopulmonary arrest (outside or inside the hospital), the duration of resuscitation process, success or failure of the resuscitation process and the mechanism of cardiopulmonary arrest were obtained. Results: From a total of 354 cases of cardiopulmonary resuscitation, 281 cases (79%) were unsuccessful and 73 cases (21%) were successful. The average age of patients was 59 ± 22 years. The average time of the resuscitation process was 31 ± 12 minutes. There was a significant difference between the mean of age and resuscitation time in patients who had experienced successful or unsuccessful resuscitation (P = 0.0001). There was a significant relationship between sex and the success rate of resuscitation (P = 0.0001). In addition, a significant relationship between the success of the resuscitation operation and the ward of resuscitation was observed (P = 0.0001). Conclusion: The most common mechanism leading to cardiopulmonary arrest among patients was asystole. In this regard, no significant difference was observed between successful and unsuccessful resuscitation processes. It was also observed that the success of resuscitation from 8 am to 4 pm was more than any other time period.
Emergency medicine
Ali Arhami Dolatabadi; Elham Memari; Majid Shojaee; Hossein Alimohammadi; Hamid Kariman; Ali Shahrami; Abdelrahman Ibrahim Abushouk3
Volume 3, Issue 1 , January 2017, , Pages 22-25
Abstract
Objective: Cardiopulmonary resuscitation (CPR) has been known in its present form since 1960. Different studies have reported variable outcomes among different countries. Therefore, the purpose of this study was to assess the rate of CPR success and the survival rate in managing cardiac arrest among ...
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Objective: Cardiopulmonary resuscitation (CPR) has been known in its present form since 1960. Different studies have reported variable outcomes among different countries. Therefore, the purpose of this study was to assess the rate of CPR success and the survival rate in managing cardiac arrest among patients in an educational medical center.
Methods: This cross-sectional study was performed at Imam Hosein hospital, Tehran, Iran. All patients, admitted to the emergency department with cardiac arrest between March 2007 and January 2008 were included. We used a formerly designed registration form and hospital documentation to retrieve the data of included patients. The main outcomes were the rate of CPR success and the survival rate of these patients.
Results: Totally 855 patients were included, from which 510 (59.64%) were males. The mean age of included patients was 63 ± 17.6. The CPR process was successful among 364 (42.58%) patients. A total number of 101 (11.82%) patients were discharged from the hospital. Different factors as the cause of cardiac arrest and past medical problems affected the probability of CPR success and the survival of patients with cardiac arrest.
Conclusion: Survival rate at hospital discharge was less than one-third of patients and nearly half of the patients received successful CPR. More intensive care unit (ICU) facilities and educational interventions for the emergency staff and the community can enhance the survival of cardiac arrest patients in our health system.
Clinical Toxicology
Ali Taherinia; Soodeh Shahsavari; Azadeh Heidarpour; Seyyed Mohammad Tabatabaii; Afsson Vahdat
Volume 2, Issue 1 , January 2016, , Pages 3-6
Abstract
Objective: Renal colic is a common cause of emergency room visits. Due to the spontaneous passage of more than 90% of kidney stones, treatment in the emergency department (ED) is limited to pain control. Analgesics currently used are selected based on physician experiences and various theories from different ...
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Objective: Renal colic is a common cause of emergency room visits. Due to the spontaneous passage of more than 90% of kidney stones, treatment in the emergency department (ED) is limited to pain control. Analgesics currently used are selected based on physician experiences and various theories from different sources. The aim of this study was to compare the common drugs (pethidine and diclofenac) used for renal colic in Iran.
Methods: In this single-blinded randomized clinical trial, 90 patients with renal colic who referred to the ED of Imam Reza hospital in Kermanshah were randomly assigned to each of 3 treatments including pethidine suppository (50 mg, iv), diclofenac suppository (50 mg), and a combination of pethidine and diclofenac suppository. In this regard, the response to treatment and duration of hospitalization were compared.
Results: The best medicine to relieve pain intensity in patients under 25 years was diclofenac suppository. In patients in the age range of 25-45 years, pethidine and diclofenac were the best choice. Conversely, in patients older than 45 years, pethidine was the best treatment. We could also observe a decrease in the length of hospitalization in patients who received pethidine.
Conclusion: It can be concluded that morphine is more appropriate to control pain and reduce the length of hospitalization in patients with renal colic. Clinical Trial Registration: irct.ir Identifier: IRCT20101214538
Emergency medicine
Maryam Eshghi; Farzad Rahmani; Behjat Derakhti; Fariba Abdollahi; Shahrad Tajoddini
Volume 2, Issue 1 , January 2016, , Pages 15-20
Abstract
Objective: Patient satisfaction is one of the most important indicators for measuring the quality of emergency services and health care. The purpose of this study was to evaluate the patients’ satisfaction in the emergency department (ED) of Sina hospital. Methods: This descriptive, cross-sectional ...
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Objective: Patient satisfaction is one of the most important indicators for measuring the quality of emergency services and health care. The purpose of this study was to evaluate the patients’ satisfaction in the emergency department (ED) of Sina hospital. Methods: This descriptive, cross-sectional study was performed during one month in Sina hospital in 2014. Data were collected by a questionnaire which its validity and reliability were confirmed in previous studies. The questionnaire consisted of 2 parts. Part 1 included the demographic characteristics and part 2 encompassed the scales of satisfactory. Data analysis was conducted by SPSS version 15. Results: Totally, 425 patients participated in this study. The mean age of patients was 41.6±17.6 years. The mean total score of patient satisfaction was 17.43±1.56. The maximum satisfaction was related to the knowledge of physicians and the minimum satisfaction was related to the remaining period in the ED. Additionally, there was a desirable satisfaction for nurses’ performances. In terms of satisfaction regarding the physical environment and the workflow of the ED, the results were moderate. There was a significant statistical difference regarding nurses and physicians behavior in the ED during different working shifts, vacation days, and workdays. Conclusion: Based on the results obtained, patients had good satisfaction for the received services in the ED. It is necessary to develop physical spaces and improve the workflow of patients in the ED.
Disaster
Alireza Baratloo; Marzieh Maleki
Volume 1, Issue 2 , July 2015, , Pages 39-39
Abstract
Today, overcrowding in emergencies has turned out to be one of the biggest problems in health systems around the world. In this case, a short and an accessible solution could not be reached. In fact, several basic reasons play a role in such a problem, and eliminating each of them would require long-term ...
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Today, overcrowding in emergencies has turned out to be one of the biggest problems in health systems around the world. In this case, a short and an accessible solution could not be reached. In fact, several basic reasons play a role in such a problem, and eliminating each of them would require long-term planning. This issue not only has a negative effect on the quality of services presented to the patients, but also produces both psychological and physical effects on the emergency staff such as physicians and nurses. In addition, it also causes increased dissatisfaction among referees as well as imposing excessive exhaustion on medical staff.
emergency nursing
Ramin Azhough; Samad Shams Vahdati; Fariba Faraji; Malihe Faraji; Maryam Ghorbanian; Ali Ramouz; Shahrad Tajoddini
Volume 1, Issue 2 , July 2015, , Pages 52-55
Abstract
Objective: Triage procedure is one of the most important aspects of emergency departments as it has an undeniable role on the management of patients. It includes 5 categories based on the Emergency Severity Index (ESI) according to the condition of severity. For better decision making and management, ...
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Objective: Triage procedure is one of the most important aspects of emergency departments as it has an undeniable role on the management of patients. It includes 5 categories based on the Emergency Severity Index (ESI) according to the condition of severity. For better decision making and management, it is important to have skillful and experienced nursing staff. In the current study, we aimed to investigate the effectiveness of a one-day workshop on participants in terms of their triage knowledge improvement.
Methods: This is a pre- and post-test trial study. In this study all the nursing staff of Sina hospital participated. The workshop was conducted in a single day for 6 hours. During the one-day workshop, topics such as emergency triage and hospital triage were covered according to START and ESI. In order to evaluate triage knowledge, each participant completed a pre-test before the workshop, and a post-test after the workshop (15 questions). Data were analyzed with SPSS 15.0. Paired t test was applied for data analysis.
Results: Fifty-five nurses with the mean age of 35.72 ± 7.35 participated in the workshop. The analysis of the data, using paired t test based on the pre-test and post-test results, did not show any significant differences (P > 0.05).
Conclusion: This study suggests that a one-day workshop is not really effective and reliable for triage knowledge improvement. We propose longer planned workshops in order to train more skillful staff.
Emergency medicine
Ali Arhami Dolatabadi; Parvin Kashani; Hamidreza Hatamabadi; Hamid Kariman; Alireza Baratloo
Volume 1, Issue 1 , January 2015, , Pages 3-6
Abstract
Objective: This study aimed to determine the association of cardiac risk factors and the risk of Acute Myocardial Infarction (AMI) in Emergency Department (ED) patients with non-diagnostic ECG changes.
Methods: This cross-sectional study was conducted in the ED of Imam Hossein Hospital during a period ...
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Objective: This study aimed to determine the association of cardiac risk factors and the risk of Acute Myocardial Infarction (AMI) in Emergency Department (ED) patients with non-diagnostic ECG changes.
Methods: This cross-sectional study was conducted in the ED of Imam Hossein Hospital during a period of one year. In this study, patients with symptoms suggestive of AMI including chest pain, dyspnea, palpitation, syncope, cerebrovascular incidents, nausea, vomitting, dizziness and loss of consciousness were included. The demographic data and risk factors, such as age, gender, history of diabetes, Hypertension (HTN), Hyperlipidemia (HLP), renal failure, positive family history of Coronary Artery Disease (CAD), smoking, substance abuse, alcohol consumption within the past 24 hours and cocaine use within the past 48 hours were recorded. Non-diagnostic ECG included: normal, non-specific, abnormal without ischemic symptoms such as old bundle branch block, Left Ventricular Hypertrophy (LVH), etc. The final diagnosis of AMI was determined by Creatine Phosphokinase-MB (CPK-MB) serum markers and Troponin I. The data were analyzed by using SPSS V. 20 and the level of statistical significance was considered to be P< 0.05.
Results: HTN, HLP, family history of heart disease were significantly higher in those who had non-diagnostic ECG (P< 0.05). However, the ischemic heart diseases were significantly lower in those with non-diagnostic ECG. History of diabetes, stroke, renal failure, alcohol or opium and menopause showed no significant association with non-diagnostic or diagnostic ECG.
Conclusion: Overall, the risk factors are limitedly associated with the occurrence of Myocardial Infarction (MI) in cases where ECG is not diagnostic and it is better to use other criteria to diagnose AMI.
Cardiology
Samad Shams Vahdati; Neda Parnianfard; Sanaz Beigzali; Shahrad Tajoddini
Volume 1, Issue 1 , January 2015, , Pages 29-34
Abstract
Objective: Acute chest pain is an important and frequently occurring symptom in patients. Chest pain is often a sign of ischemic heart disease. Chest pain due to suspected Acute Coronary Syndrome (ACS) is responsible for a large and ijncreasing number of hospital attendances and admissions. Current practice ...
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Objective: Acute chest pain is an important and frequently occurring symptom in patients. Chest pain is often a sign of ischemic heart disease. Chest pain due to suspected Acute Coronary Syndrome (ACS) is responsible for a large and ijncreasing number of hospital attendances and admissions. Current practice for suspected ACS involves troponin testing 10–12 hours after symptom onset to diagnose Myocardial Infarction (MI). Patients with a negative troponin can be investigated further with Computed Tomographic Coronary Angiography (CTCA) or exercise Electrocardiography (ECG). A review of cardiac biomarkers as screening test in acute chest pain over 15 years was conducted. Separate searches were under taken for biomarkers. We Searched electronic databases up to 2004-2014, reviewed citation lists and contacted experts to identify diagnostic and prognostic studies comparing a relevant index test (biomarker, CTCA or exercise ECG) to the appropriate reference standard. We classified studies to two part early rise biomarkers, high sensitivity biomarkers.
Conclusion: Although presentation troponin has suboptimal sensitivity, measurement of a 10-hour troponin level is unlikely to be cost-effective in most scenarios compared with a high sensitivity presentation troponin. Measurement of cardiac troponin using a sensitive method was the best test for the early diagnosis of an Acute Myocardial Infarction (AMI). Measurement of myoglobin or Creatine Kinase-MB (CK-MB) in addition to a sensitive troponin test is not recommended. Heart-type Fatty Acid-Binding Protein (H-FABP) shows promise as an early marker and requires further study.