Annals of emergency medicine
-
Multicenter Study Comparative Study
Prospective multicenter study of quantitative pretest probability assessment to exclude acute coronary syndrome for patients evaluated in emergency department chest pain units.
We compare the diagnostic accuracy of 3 methods--attribute matching, physician's written unstructured estimate, and a logistic regression formula (Acute Coronary Insufficiency-Time Insensitive Predictive Instrument, ACI-TIPI)--of estimating a very low pretest probability (< or = 2%) for acute coronary syndromes in emergency department (ED) patients evaluated in chest pain units. ⋯ In a low-risk ED population with symptoms suggestive of acute coronary syndrome, patients with a quantitative pretest probability less than or equal to 2%, determined by attribute matching, unstructured estimate, or logistic regression, may not require additional diagnostic testing.
-
Multicenter Study
Evaluation and treatment of patients with severely elevated blood pressure in academic emergency departments: a multicenter study.
Current guidelines advise that emergency department (ED) patients with severely elevated blood pressure be evaluated for acute target organ damage, have their medical regimen adjusted, and be instructed to follow up promptly for reassessment. We examine factors associated with performance of recommended treatment of patients with severely elevated blood pressure. ⋯ The majority of ED patients with severely elevated blood pressure do not receive the evaluation, medical regimen modification, and discharge instructions advised by current guidelines. Further study is necessary to determine whether these recommendations are appropriate in this setting.
-
Multicenter Study
Analysis of current management of atrial fibrillation in the acute setting: GEFAUR-1 study.
Limited information relative to the management of atrial fibrillation in the emergency department (ED) daily practice is available. This study evaluates current management of atrial fibrillation in this setting to identify areas for practice improvement. ⋯ In our ED population, rate-control effectiveness is poor and rhythm control is not attempted in most recent-onset episodes. Methods to improve rate-control effectiveness, the selection of patients for rhythm control, and the use of electrocardioversion appear warranted.
-
Multicenter Study Comparative Study
Artificial neural network models for prediction of acute coronary syndromes using clinical data from the time of presentation.
Clinical and ECG data from presentation are highly discriminatory for diagnosis of acute coronary syndromes, whereas definitive diagnosis from serial ECG and cardiac marker protein measurements is usually not available for several hours. Artificial neural networks are computer programs adept at pattern recognition tasks and have been used to analyze data from chest pain patients with a view to developing diagnostic algorithms that might improve triage practices in the emergency department. The aim of this study is to develop and optimize artificial neural network models for diagnosis of acute coronary syndrome, to test these models on data collected prospectively from different centers, and to establish whether the performance of these models was superior to that of models derived using a standard statistical technique, logistic regression. ⋯ This study confirms that artificial neural networks can offer a useful approach for developing diagnostic algorithms for chest pain patients; however, the exceptional performance and simplicity of the logistic model militates in favor of logistic regression for the present task. Our artificial neural network models were well calibrated and performed well on unseen data from different centers. These issues have not been addressed in previous studies. However, and unlike in previous studies, we did not find the performance of artificial neural network models to be significantly different from that of suitably optimized logistic regression models.
-
Multicenter Study
Airway management by US and Canadian emergency medicine residents: a multicenter analysis of more than 6,000 endotracheal intubation attempts.
We determine success rates of endotracheal intubation performed in emergency departments (EDs) by North American emergency medicine residents. ⋯ Success of initial intubation attempts increased over the first 3 years of residency. This large multicenter study demonstrates the success of airway management by emergency medicine residents in North America. Using rapid-sequence intubation predominantly, emergency medicine residents achieved high levels of success.