Combining Thrombolysis in Myocardial Infarction risk score and clear-cut alternative diagnosis for chest pain risk stratification.

Objective: The Thrombolysis in Myocardial Infarction (TIMI) risk score is a validated risk stratification tool useful in patients with definite and potential acute coronary syndromes (ACS) but does not identify patients safe for discharge from the emergency department (ED). Likewise, the use of a clear-cut alternative noncardiac diagnosis risk stratifies patients but does not identify a group safe for discharge. We hypothesized that the presence of an alternative diagnosis in patients with a TIMI risk score less than 2 might identify a cohort of patients safe for ED discharge.

Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain.

Objectives: Oligoanalgesia for acute abdominal pain historically has been attributed to the provider's fear of masking serious underlying pathology. The authors assessed whether a gender disparity exists in the administration of analgesia for acute abdominal pain.

Methods: This was a prospective cohort study of consecutive nonpregnant adults with acute nontraumatic abdominal pain of less than 72 hours' duration who presented to an urban emergency department (ED) from April 5, 2004, to January 4, 2005.

Derivation of a clinical prediction rule for evaluating patients with abdominal pain and diarrhea.

Objective: The objective of the study was to develop a simple prediction rule to reliably identify abdominal pain patients with diarrhea who may require surgical intervention.

Methods: We performed a secondary analysis of a prospective cohort study of adults with acute nontraumatic abdominal pain and diarrhea in an urban emergency department (ED). Structured data collection included 109 historical and 28 physical examination items, laboratory and radiographic results, and final diagnosis.

Emergency physicians do not use more resources to evaluate obese patients with acute abdominal pain.

Objective: We hypothesized that emergency physicians would use more resources to evaluate acute abdominal pain in obese patients as compared with that in nonobese patients.

Methods: We conducted a secondary analysis of a prospective cohort of adults with acute abdominal pain. Collected data included self-reported height and weight, demographics, medical history, laboratory and x-ray results, and final diagnosis.

TIMI risk score: does it work equally well in both males and females?

Objective: The TIMI (Thrombolysis In Myocardial Infarction) risk score is a seven item risk stratification tool derived from trials of patients with non-ST segment elevation acute coronary syndromes (ACS) that has been validated in emergency department (ED) patients with potential ACS. We hypothesised that it might have different prognostic abilities in male and female patients.

Methods: This was a prospective cohort study of ED patients with potential ACS.

The risk for acute coronary syndrome associated with atrial fibrillation among ED patients with chest pain syndromes.

Objective: We sought to determine if atrial fibrillation is associated with an increased risk for an acute coronary syndrome (ACS) among emergency department (ED) patients with chest pain syndromes.

Methods: We performed a retrospective analysis of a prospectively collected database on ED patients with chest pain by selecting patients with atrial fibrillation and frequency-matched control subjects without atrial fibrillation. Measured outcomes were acute myocardial infarction (AMI), ACS, and unstable angina (UA).

Gender bias in cardiovascular testing persists after adjustment for presenting characteristics and cardiac risk.

Objectives: Previous studies have found that female patients receive fewer invasive tests for cardiovascular disease than male patients. The authors assessed whether different clinical characteristics at emergency department presentation account for this gender bias.

Methods: Patients with potential acute coronary syndrome (ACS) who presented to a university hospital were prospectively identified.

Discordance between serum creatinine and creatinine clearance for identification of ED patients with abdominal pain at risk for contrast-induced nephropathy.

Study Objective: Despite creatinine clearance (CrCl) being a better estimate of renal function, serum creatinine (Cr) is more commonly used to screen for renal insufficiency in patients scheduled for an enhanced abdominal computed tomography (CT) in an attempt to reduce the likelihood of contrast-induced nephropathy (CIN). Our objective was to determine the incidence of renal insufficiency (a CrCl <60 mL/min) among patients who have serum Cr below 1.5 mg/dL (the most commonly accepted Cr cutoff for the administration of intravenous contrast).

The impact of B-type natriuretic peptide in addition to troponin I, creatine kinase-MB, and myoglobin on the risk stratification of emergency department chest pain patients with potential acute coronary syndrome.

Study Objective: The emergency department (ED) evaluation of chest pain patients with potential acute coronary syndrome is limited by the initial sensitivity of cell injury markers. BNP is increased during myocardial ischemia and is associated with adverse outcomes. We determine whether the addition of B-type natriuretic peptide (BNP) to troponin I, creatine kinase-MB (CK-MB), and myoglobin increases the sensitivity and negative predictive value (NPV) for acute myocardial infarction, acute coronary syndrome, and 30-day adverse events among chest pain patients with potential acute coronary syndrome.

Prospective validation of the Thrombolysis in Myocardial Infarction Risk Score in the emergency department chest pain population.

Study Objective: The Thrombolysis in Myocardial Infarction (TIMI) risk score is a 7-item tool derived from trials of patients with unstable angina/non-ST segment elevation myocardial infarction for risk stratification with respect to outcomes. It has been retrospectively evaluated in emergency department (ED) patients with potential acute coronary syndrome but has not been prospectively validated in this patient population. To validate the use of the TIMI risk score in the ED, we prospectively assess its potential utility in a broad ED chest pain patient population.

Application of the TIMI risk score for unstable angina and non-ST elevation acute coronary syndrome to an unselected emergency department chest pain population.

Objectives: Patients presenting with chest pain or related symptoms suggestive of myocardial ischemia, without ST-segment elevation (NSTE) on their presenting electrocardiograms, often present a diagnostic challenge in the emergency department (ED). Prompt and accurate risk stratification to identify those patients with NSTE chest pain who are at highest risk for adverse events is essential, however, to optimal management. Although validated and used frequently in patients already enrolled in acute coronary syndrome trials, the Thrombolysis in Myocardial Infarction (TIMI) risk score never has been examined for its value in risk stratification in an all-comers, non-trial-based ED chest pain population.

Evaluation of a clinical decision rule for young adult patients with chest pain.

Objectives: The authors sought to validate a clinical decision rule that young adult (younger than 40 years) chest pain patients without known cardiac disease who had either no cardiac risk factors and/or a normal electrocardiogram (ECG) are at low risk (<1%) for acute coronary syndromes (ACS) and 30-day adverse cardiovascular (CV) events.

Methods: A prospective cohort study of patients 24-39 years old who received an ECG for chest pain from July 1999 to March 2002 were included. Cocaine users were excluded.

Impact of a negative evaluation for underlying coronary artery disease on one-year resource utilization for patients admitted with potential acute coronary syndromes.

Unlabelled: Reduction in emergency department (ED) overcrowding is a major Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) initiative. One major source of ED overcrowding is patients waiting for telemetry beds.

Objective: To determine whether, in patients admitted with a potential acute coronary syndrome, a negative evaluation for underlying coronary artery disease would reduce ED and hospital revisits over the subsequent year compared with patients who did not receive an evaluation for underlying coronary artery disease.

Assessment of the standardized reporting guidelines ECG classification system: the presenting ECG predicts 30-day outcomes.

Study Objective: Standardized reporting criteria for risk stratification studies of patients with potential acute coronary syndromes have been proposed. We sought to determine whether the categories in the recommended 6-item ECG classification system predict rates of 30-day death, myocardial infarction, and revascularization.

Methods: We conducted a prospective cohort study of emergency department (ED) chest pain patients who presented to a tertiary care center during a 32-month period.

Effects of neural network feedback to physicians on admit/discharge decision for emergency department patients with chest pain.

Study Objective: Neural networks can risk-stratify emergency department (ED) patients with potential acute coronary syndromes with a high specificity, potentially facilitating ED discharge of patients to home. We hypothesized that the use of "real-time" neural networks would decrease the admission rate for ED chest pain patients.

Methods: We conducted a before-and-after trial.