Articles: emergency-services.
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Case Reports Multicenter Study Clinical Trial
Acute cardiac ischemia in patients with syncope: importance of the initial electrocardiogram.
To determine the prevalence of acute cardiac ischemia in emergency department (ED) syncope patients without chest pain and to determine which of these patients are at high risk for acute cardiac ischemia. ⋯ For syncope patients who have no chest pain or ischemic abnormality on the presenting ECG in the ED, acute ischemia appears to be unlikely. Admission to the cardiac care unit for these patients for possible myocardial ischemia is probably unnecessary. However, patients who have syncope and ischemic abnormalities on the ECG are at risk for acute cardiac ischemia, even in the absence of chest pain. Hospital admission to rule out myocardial infarction for these patients is prudent.
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Multicenter Study Clinical Trial
Physician electrocardiogram reading in the emergency department--accuracy and effect on triage decisions: findings from a multicenter study.
To determine how well physicians in emergency departments read electrocardiographic (ECG) ST-segment and T-wave changes and how this affects triage decisions. ⋯ Physicians in emergency departments often misread the ST segments and T waves of patients with possible acute cardiac ischemia. Misreading is related to suboptimal triage and unnecessary CCU admission. Training emergency physicians to make these distinctions more accurately could improve medical care and hospital utilization.
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Multicenter Study Comparative Study Clinical Trial
Use of emergency departments by elderly patients: projections from a multicenter data base.
To assess the use of emergency medical care by the elderly in the United States, including emergency department visits, level of ED care required, ambulance services, and hospital admission rate. ⋯ With the rapid growth of the size of the elderly population, it is important that we assess the emergency medical resources needed to care for the geriatric population.
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Multicenter Study Comparative Study Clinical Trial
Geriatric patient emergency visits. Part II: Perceptions of visits by geriatric and younger patients.
To compare group perceptions of reasons for emergency department care, ED use patterns, and the effect of illness on self-care ability for elderly and younger adult patients. ⋯ The elderly use the ED for reasons similar to those for younger adults. Often they feel too ill to wait for an office visit or are referred in by their primary care provider. Elderly patients more commonly have difficulty with self care after release home, and emergency physicians must plan accordingly.
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Multicenter Study Clinical Trial
Impact of the availability of a prior electrocardiogram on the triage of the patient with acute chest pain.
To determine whether information from a prior electrocardiogram (ECG) improves diagnostic accuracy in the emergency department (ED) evaluation of patients with acute chest pain. ⋯ When the current ECG is consistent with ischemia or infarction, the availability of a prior ECG for comparison to determine whether the ECG changes are old or new improves diagnostic accuracy and triage decisions by reducing the admission of patients without AMI or acute ischemic heart disease (increased specificity) without reducing the admission of patients with these diagnoses (unchanged sensitivity).