The American journal of emergency medicine
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Multicenter Study Clinical Trial
Combined copeptin and troponin to rule out myocardial infarction in patients with chest pain and a history of coronary artery disease.
The main objective of this multicentric study was to evaluate the additional value of copeptin to conventional cardiac troponin (cTn) for a rapid ruling out of acute myocardial infarction (AMI) in patients with acute chest pain and a previous history of coronary artery disease (CAD). ⋯ In triage patients with acute chest pain lasting for less than 6 hours and a previous history of CAD, the combination of copeptin and cTn allows for the ruling out AMI, with a negative predictive value greater than 95%.
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Multicenter Study
Killip classification in patients with acute coronary syndrome: insight from a multicenter registry.
The purpose of this study was to assess the prognostic value of the Killip classification at the presentation in patients with acute coronary syndrome (ACS). In 2007 and over 5 months, 6704 consecutive patients with ACS were enrolled in the Gulf Registry of Acute Coronary Events. Patients were categorized according to Killip classification at presentation (Classes I, II, III, and IV). ⋯ In conclusion, across ACS, patients with higher Killip class had worse clinical profile and were less likely to be treated with evidence-based therapy. High Killip class was independent predictors of mortality in ST-elevation myocardial infarction and non-ST-elevation acute coronary syndrome. Physician in the emergency department should be aware of the importance of clinical examination in the risk stratification in patients presenting with ACS.
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Multicenter Study
Identification of potential organ donors of advanced age in EDs.
In France and in Belgium, as in many countries, there is a shortage of organs for transplantation, which has led to strategies to recruit older potential donors who may die of stroke. ⋯ A significant number of patients who die in emergency departments could be organ donors, including approximately 7% between 60 and 85 years of age with life-threatening neurologic diseases. However, this percentage may be reduced by family opposition. Emergency physicians should collaborate with intensive care units and local organ donation teams to optimize end-of-life care and maximize the number of potential donors.
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Multicenter Study Clinical Trial
Efficacy of 2 interventions for panic disorder in patients presenting to the ED with chest pain.
Brief and efficacious interventions for panic disorder (PD) in patients presenting to emergency departments (EDs) for chest pain are essential. This study assessed the effects of 2 interventions for this population: a brief cognitive-behavioral therapy delivered by psychologists, and a 6-month pharmacologic treatment initiated and managed by the ED physician. The relative efficacy of both interventions was also examined. ⋯ Taken together, these findings suggest that empirically validated interventions for PD initiated in an ED setting can be feasible and efficacious, and future studies should assess their impact on both the direct (ie, health care utilization) and indirect (ie, lost productivity) costs associated with PD morbidity in this population.
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Multicenter Study
Circadian, weekly, and seasonal mortality variations in out-of-hospital cardiac arrest in Japan: analysis from AMI-Kyoto Multicenter Risk Study database.
Several studies have reported circadian, weekly, and seasonal variations in the rates of out-of-hospital cardiac arrest (OHCA). However, variations in the mortality of OHCA are not well known. ⋯ The present analyses demonstrated circadian, weekly and seasonal variations in the occurrence, and a seasonal variation in mortality in OHCA. Changes in temperature might influence the severity of OHCA and change the rate of success of cardiopulmonary resuscitation.