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1.
Background
Spontaneous coronary artery dissection (SCAD) causes acute coronary syndromes or sudden death in young patients who are often lacking classic coronary disease risk factors. Systemic inflammatory and connective tissue diseases have been suggested as risk factors for SCAD.Objective
To review the risk factors, diagnosis, and management of this uncommon but life-threatening disease.Case Report
We report a case of a 27-year-old woman with a history of an ill-defined inflammatory arthropathy who presented with an acute ST-elevation myocardial infarction. SCAD was diagnosed by coronary angiography. Percutaneous coronary intervention was attempted but was unsuccessful. The patient recovered uneventfully with medical management and was ultimately diagnosed with systemic lupus erythematosus.Conclusions
SCAD is a rare but important cause of acute coronary syndromes and sudden death. It commonly occurs in young women. Although pregnancy is the most well-established risk factor, systemic inflammatory and connective tissue diseases have also been suggested as risk factors. 相似文献2.
Rachel A. Lindor Marysia S. Tweet Kiran A. Goyal Christine M. Lohse Rajiv Gulati Sharonne N. Hayes Annie T. Sadosty 《The Journal of emergency medicine》2017,52(3):286-291
Background
Spontaneous coronary artery dissection (SCAD) is an infrequently recognized but potentially fatal cause of acute coronary syndrome (ACS) that disproportionately affects women. Little is currently known about how patients with SCAD initially present.Objectives
We sought to describe patients who presented to the emergency department (ED) with symptoms of SCAD to improve providers’ awareness and recognition of this condition.Patients and Methods
We performed a retrospective medical record review of all patients who presented to the ED of a single academic medical center from January 1, 2002 through October 31, 2015 and were subsequently diagnosed with SCAD by angiography. These patients were identified by International Classification of Diseases, Ninth Revision codes and a Boolean search of the diagnosis field of the medical record. Data regarding patients’ presentations and course were abstracted by two independent reviewers.Results
We identified 20 episodes of SCAD involving 19 patients, all of whom were female. The majority of patients had 0–1 conventional cardiovascular disease risk factors. Most patients had chest pain (85%), initial electrocardiograms without evidence of ischemia (85%), and elevated initial troponin (72%). The most common diagnosis in providers’ differential was acute coronary syndrome (ACS).Conclusion
Patients with SCAD present with similar symptoms compared to patients with ACS caused by atherosclerotic disease, but have different risk profiles. Providers should consider SCAD in patients presenting with symptoms concerning for ACS, especially in younger female patients without traditional cardiovascular disease risk factors, as their risk may be significantly underestimated with commonly used ACS risk-stratifiers. 相似文献3.
Carlo Arrigo Massimo Bochicchio Sabina Pezzotti Massimo Amato Luisa Carminati Giuliano Crocco Alessandra Mora Carlo Mosca Giuliano Chizzola 《The Journal of emergency medicine》2013
Background
Spontaneous coronary artery dissection is a very rare event and is more common in women than in men. Pregnancy and the early puerperium stage have been recognized as predisposing factors for this condition.Case Report
A 33-year-old woman presented to the Emergency Department (ED) with chest pain; the patient's electrocardiogram (ECG) showed an ST-segment elevation similar to that observed in ST-segment elevation myocardial infarction (STEMI). She experienced a ventricular fibrillation cardiac arrest when she was in the hospital and received resuscitation, after which she regained consciousness and showed spontaneous circulation. She underwent cardiac catheterization under the impression of spontaneous coronary artery dissection, and conservative therapy was chosen.Conclusion
In this report, we have underlined the importance of considering coronary artery dissection in the differential diagnosis of young women who present to the ED with chest pain, an ECG with ST-segment elevation, and very few cardiac risk factors. 相似文献4.
Jose L. Diaz-Miron Patrick A. Dillon Arun Saini David T. Balzer Jasvindar Singh Nikoleta S. Kolovos Jennifer G. Duncan Martin S. Keller 《The Journal of emergency medicine》2014
Background
Traumatic coronary artery dissection (CAD) after blunt chest trauma (BCT) is extremely rare, particularly in children. Among coronary dissections, left main coronary artery (LMCA) dissection is the least common, with only two pediatric cases reported previously. Manifestations of coronary dissections can range from ST segment changes to sudden death. However, these manifestations are not specific and can be present with other cardiac injuries. To our knowledge we present the first pediatric case of traumatic LMCA dissection after sport-related BCT that was treated successfully with coronary stenting.Case Report
A 14-year-old child sustained BCT during a baseball game. Early in the clinical course, he had episodes of ventricular dysrhythmias, diffuse ST changes, rising troponin I, and hemodynamic instability. Emergent cardiac catheterization revealed an LMCA dissection with extension into the proximal left anterior descending artery (LADA). A bare metal stent was placed from the LMCA to the LADA, which improved blood flow through the area of dissection. He has had almost full recovery of myocardial function and has been managed as an outpatient with oral heart failure and antiplatelet medications.Why Should an Emergency Physician Be Aware of This?
Our case highlights that CAD, although rare, can occur after pediatric BCT. Pediatric emergency responders must have a heightened awareness that evidence of ongoing myocardial ischemia, such as evolving and focal myocardial infarction on electrocardiogram, persistent elevation or rising troponin I, and worsening cardiogenic shock, can represent a coronary event and warrant further evaluation. Cardiac catheterization can be both a diagnostic and therapeutic modality in such cases. Early recognition and management is vital for myocardial recovery. 相似文献5.
Yanping Zha Yong Chen Fayun Xu Tian Li Chuanyan Zhao Lianqun Cui 《Biomedicine & Pharmacotherapy》2010
Objective
A recent study indicates that ADAMTS4 (a disintegrin and metalloprotease with thrombospondin motifs 4) was expressed in macrophage rich areas of human atherosclerotic carotid plaques and coronary unstable plaques suggesting a pathogenic role in the development of acute coronary syndromes (ACS). The aim of the study was to compare ADAMTS4 across the entire spectrum of coronary artery disease (CAD) and to investigate the temporal profiles of ADAMTS4.Methods
Plasma levels of ADAMTS4 were measured in patients with stable effort angina pectoris (SAP), ACS and in controls. Venous blood was sampled upon admission before angiography and drug administration. In patients with ACS who underwent medical treatment, serial blood samples were also collected on days 1, 2, 3, 5 and 7 after admission. ADAMTS4 was measured using an enzyme immunoassay.Results
Plasma ADAMTS4 level in cases was significantly greater than in controls (P < 0.001). Higher levels of ADAMTS4 were found with progression of CAD from SAP to unstable angina pectoris (UAP) to non-ST-segment elevation acute myocardial infarction (NSTEMI) and to ST-segment elevation acute myocardial infarction (STEMI) (P < 0.001). Elevated ADAMTS4 level was associated with ACS with an area under receiver operating characteristic (ROC) curve of 0.753 (95% CI 0.654–0.851; P < 0.001). The pattern of ADAMTS4 release observed was clearly different in various forms of ACS. ADAMTS4 showed a weak correlation with high-sensitivity C-reactive protein (hs-CRP); however, no significant correlation was found between ADAMTS4 and troponin T (TnT) in ACS patients.Conclusions
Serial changes in plasma ADAMTS4 were documented in patients with ACS and may serve as a marker of plaque destabilization. 相似文献6.
Background
The use of cannabis is not usually regarded as a risk factor for acute coronary syndrome. However, several cases of myocardial infarction (MI) associated with cannabis use have been reported in the scientific literature. The etiology of this phenomenon is not known.Objectives
To present a case of cannabis-associated MI in which atherosclerotic coronary disease was excluded as a potential etiology by intravascular ultrasound examination, and briefly review the other possible mechanisms by which this effect may be mediated.Case Report
We present the case of a previously healthy 21-year-old man who regularly smoked cannabis and presented to the Emergency Department with ST-elevation myocardial infarction after participating in a sport. He was also a cigarette smoker, but had no other conventional cardiovascular risk factors. At coronary angiography, a large amount of thrombus was found in the left anterior descending coronary artery. He recovered with medical treatment, and subsequent intravascular ultrasound examination showed no evidence of atherosclerosis at the site of the thrombus.Conclusion
Cannabis-associated MI is increasingly recognized. The etiology is unclear, but we believe this is the first report of the phenomenon where atherosclerotic plaque rupture has been excluded as the cause with a high degree of confidence. 相似文献7.
Tolga Sinan Güvenç Hatice Betül ErerRengin Çetin MD Hakan HasdemirErkan İlhan MD Ceyhan TürkkanMehmet Eren MD FESC 《The Journal of emergency medicine》2013
Background
Aortic dissection is an important cause of acute chest pain that should be rapidly diagnosed, as mortality increases with each hour this condition is left untreated. The diagnosis can be challenging, especially if concomitant myocardial infarction is present. Echocardiography is an important tool for the differential diagnosis.Objectives
To stress the importance of recognizing aortic regurgitation for the differentiation of myocardial infarction and aortic dissection.Case Report
An 80-year-old woman was admitted to our hospital with chest pain that was diagnosed as inferior and lateral wall myocardial infarction based on electrocardiographic findings. The diagnosis was reevaluated when aortic regurgitation was detected on echocardiography. Closer inspection of the ascending aorta revealed a dissection flap as the cause of aortic regurgitation.Conclusion
Detection of aortic regurgitation in a patient with myocardial infarction and normal valves should prompt the search for a possible aortic dissection, whether or not the dissection flap can be visualized. 相似文献8.
Holly Morgan Michael McCann Alan Whelan Richard Clugston 《The Journal of emergency medicine》2017,52(6):e233-e236
Background
ST-elevation myocardial infarction (STEMI) leading to cardiac arrest is an exceptionally rare occurrence in young adults. Those affected tend to abuse sympathomimetic drugs, have strong family histories, or have a significant burden of cardiac risk factors. Another uncommon cause of STEMI is coronary artery dissection, which overwhelmingly affects middle- and older-aged women with few cardiac risk factors.Case Report
A 22-year-old athlete with no medical history was admitted to our institution post–cardiac arrest with an anterior STEMI and concomitant right coronary dissection. To our knowledge, this represents the first documented case of these simultaneous pathologies in a young cardiac arrest survivor.Why Should an Emergency Physician Be Aware of This?
Myocardial infarction is rare in young adults, and a diverse range of etiologies must be considered promptly to prevent delays in time-sensitive therapies, such as antiplatelet agents and revascularization. The emergency physician is most often the first point of contact in patients with acute coronary syndromes, and the failure to recognize it in young adults threatens them with premature death and potentially life-long disability. 相似文献9.
Sumbul Javed Mirza Khalifa Omar MohammedFahad Omar Baslaib MD FACC 《The Journal of emergency medicine》2014
Background
Kawasaki disease usually affects infants and young children. It often goes unrecognized in adults due to varying symptoms and lack of definite diagnostic criteria.Objectives
To describe the potential for acute myocardial infarction as a complication of antecedent Kawasaki Disease (KD).Case Report
We describe a case of a 19-year-old man who presented to the Emergency Department (ED) with an acute myocardial infarction that was subsequently determined to be the result of previously untreated KD.Conclusion
Kawasaki disease can cause coronary complications in a teenager. A high level of suspicion in the ED can help in proper management of these patients. 相似文献10.
Background
Diabetes mellitus (DM) is a powerful independent risk factor for multivessel, diffuse coronary artery disease (CAD). The optimal coronary revascularization strategy in DM is not clearly defined, but past trials have suggested an advantage for coronary artery bypass grafting (CABG). Recently, the Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM) trial found patients randomized to CABG had lower rates of death and myocardial infarction (MI) compared with those randomized to percutaneous coronary intervention (PCI).Objective
This article reviews the contemporary management of patients with DM presenting with acute coronary syndromes, particularly ST-elevation MI, in the post-FREEDOM era.Methods
We undertook a comprehensive review of published literature addressing trials in this field performed to address current knowledge both in the pre- and post-FREEDOM era.Results
The implications of FREEDOM for patients with acute coronary syndrome are that CABG provides a significant benefit, compared with PCI with drug-eluting stents, to patients with DM and multivessel coronary artery disease; and that patients similar to those enrolled in FREEDOM should receive CABG in preference to PCI. The relevance of FREEDOM’s findings to the large proportion of patients who would not meet inclusion criteria—including patients with an acute coronary syndrome undergoing an early or emergent invasive strategy, remains uncertain.Discussion
FREEDOM’s outcomes have generated uncertainty regarding best practice once thrombolysis in myocardial infarction grade 3 flow is re-established in patients with DM and multivessel disease. Current interventional guidelines recommend optimally treating the culprit artery; however, decisions made at the time of revascularization influence future revascularization strategies, particularly stent choice and resultant P2Y12 receptor antagonist therapy. The preferred method for future revascularization may be questioned if the patient's residual coronary stenoses do not, post-PCI, meet the FREEDOM inclusion criteria, or where the left anterior descending artery is the infarct-related artery, and after left anterior descending artery PCI the patient would not receive an internal mammary graft. The management of residual disease and the preferred (further) revascularization strategy needs to be tested in an appropriately powered randomized trial.Conclusions
The optimal revascularization strategy in patients with acute coronary syndrome, diabetes, and multivessel disease, in particular those with ST elevation, is unclear, and not guided by level A (or B) evidence. Currently CABG is favored over PCI, and an individually tailored, collaborative approach, guided by a multidisciplinary heart team, should be employed. 相似文献11.
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Danny Liew Richard De Abreu Lourenço Michael Adena Lesley Chim Philip Aylward 《Clinical therapeutics》2013
Background
The PLATO (Platelet Inhibition and Patient Outcomes) randomized trial (NCT00391872) in patients with acute coronary syndromes (ACS) reported that ticagrelor (in addition to aspirin) reduced the rate of the composite end point of myocardial infarction (MI), stroke, or cardiovascular death compared with clopidogrel (in addition to aspirin) by 16% over 12 months (P < 0.001). No significant difference in the incidence of major bleeding was noted, but ticagrelor was associated with a higher rate of major bleeding not related to coronary artery bypass grafting.Objective
By extrapolating the key findings of PLATO, we sought to assess the cost-effectiveness of ticagrelor compared with clopidogrel in the management of ACS in a contemporary Australian setting.Methods
A Markov model with 4 health states (free from further ACS events, MI, stroke, and death) was developed to simulate the long-term costs and outcomes associated with ACS. Event risks were based on data derived directly from PLATO, and costs and utilities were drawn from published sources. A 10-year time horizon was simulated, and future costs and benefits were discounted at a 5% annual rate. However, treatment with ticagrelor and clopidogrel was only assumed for the first 12 months, with no benefits applied beyond drug cessation. Sensitivity analyses were undertaken based on variations to key data inputs. All costs for resource use applied in the analysis were based on published Australian prices (in 2010/2011 dollars [A$]).Results
Over 10 years, the estimated quality-adjusted life-years lived per-patient were 5.74 and 5.68 for ticagrelor and clopidogrel, respectively. Net costs were A$19,132 for ticagrelor and A$18,428 for clopidogrel. These equated to an incremental cost-effectiveness ratio of A$9031 per quality-adjusted life-year gained for ticagrelor compared with clopidogrel. Sensitivity analyses indicated the result to be robust.Conclusions
When assessed from the perspective of the Australian health care system, ticagrelor is likely to be cost-effective compared with clopidogrel in preventing downstream morbidity and mortality associated with ACS. 相似文献14.
Background
Pre-excitation syndromes can elicit electrocardiogram (ECG) abnormalities that are nearly identical to those associated with acute myocardial ischemia. In the presence of atypical symptoms, stable hemodynamics, and unremarkable levels of cardiac enzymes, the decision whether to subject these patients to coronary angiography, or even non-invasive testing, can be difficult.Objective
To understand that pre-excitation syndrome can mimic acute myocardial injury, but should not preclude a complete ischemic work-up.Case Report
A 53-year-old man with Wolff-Parkinson-White pattern and coronary artery disease risk factors presented with new-onset substernal chest pain. A baseline ECG was significant for hyperacute T waves. After refusing cardiac catheterization, he was admitted to the cardiac care unit for intravenous heparin and eptifibatide. Although his stay was unremarkable and resting echocardiogram showed normal contractility and valve function, treadmill stress testing was negative for ischemic change, but revealed ST-segment depression with maximum stress in the lateral precordial leads. This was thought to be a “false positive” secondary to his conduction abnormality.Conclusion
No reliable algorithm exists for making an ECG diagnosis of myocardial infarction in the presence of a pre-excitation syndrome. Similarly, current non-invasive modalities have limitations in detecting jeopardized myocardium. If acute or hyperacute injury is suspected, the patient should be emergently referred for cardiac catheterization. 相似文献15.
Alfred Ngako Aline Santin François Hémery Mirna Salloum Marie-Jeanne Calmettes Jérôme Hervé Jean-Claude Grégo Eric Roupie Patrick Maison Bertrand Renaud 《The American journal of emergency medicine》2009
Purposes
To identify bedside variables that aid in diagnosis of acute coronary syndrome (ACS) and might facilitate rapid triage of patients aged ≥65 years.Basic Procedures
Prospective, observational study of consecutive patients aged ≥65 years with suspicion of ACS presenting to our emergency department (ED). Patients' medical characteristics were collected at baseline and during a 1-month follow-up period. We identified variables independently associated with ACS by multivariate analyses and bootstrapping techniques.Main Findings
Among 399 patients, 124 (31.1%) received a diagnosis of ACS (61 acute myocardial infarction, 63 unstable angina). We surveyed multiple clinical and ECG variables to develop a predictive model which included the following variables: male sex, history of coronary artery disease, typical chest pain, dyspnea, epigastric pain, pathological Q-wave, ST-segment elevation (area under the receiver operating characteristic curve (AUC) 0.79, 95% confidence interval 0.71 to 0.82). With the addition of cardiac troponin I to the model the AUC increased to 0.83 (0.79 to 0.88). We used these findings to create the Heart Attack Risk for aged Patient (HARP) scale. Our data suggest that patients with a low HARP score might be safely managed without further testing.Principal Conclusions
A model based on variables easily available at ED presentation from history, physical examination, and electrocardiography, can help ED physicians to identify seniors at very low risk of ACS. 相似文献16.
Olan A. Soremekun Azita Hamedani Frances S. Shofer Katie J. O'Conor James Svenson Judd E. Hollander 《The American journal of emergency medicine》2014
Background
Most patients at low to intermediate risk for an acute coronary syndrome (ACS) receive a 12- to 24-hour “rule out.” Recently, trials have found that a coronary computed tomographic angiography–based strategy is more efficient. If stress testing were performed within the same time frame as coronary computed tomographic angiography, the 2 strategies would be more similar. We tested the hypothesis that stress testing can safely be performed within several hours of presentation.Methods
We performed a retrospective cohort study of patients presenting to a university hospital from January 1, 2009, to December 31, 2011, with potential ACS. Patients placed in a clinical pathway that performed stress testing after 2 negative troponin values 2 hours apart were included. We excluded patients with ST-elevation myocardial infarction or with an elevated initial troponin. The main outcome was safety of immediate stress testing defined as the absence of death or acute myocardial infarction (defined as elevated troponin within 24 hours after the test).Results
A total of 856 patients who presented with potential ACS were enrolled in the clinical pathway and included in this study. Patients had a median age of 55.0 (interquartile range, 48-62) years. Chest pain was the chief concern in 86%, and pain was present on arrival in 73% of the patients. There were no complications observed during the stress test. There were 0 deaths (95% confidence interval, 0%-0.46%) and 4 acute myocardial infarctions within 24 hours (0.5%; 95% confidence interval, 0.14%-1.27%). The peak troponins were small (0.06, 0.07, 0.07, and 0.19 ng/mL).Conclusions
Patients who present to the ED with potential ACS can safely undergo a rapid diagnostic protocol with stress testing. 相似文献17.
Background
Post-menopausal women are at significant risk for coronary artery disease, have increased rates of depression compared to their male counterparts, and often present atypically with coronary insufficiency. The symptoms of depression and coronary ischemia overlap greatly. Complaints like fatigue, body aches, and sleep disturbance reported by a depressed elderly woman may be cardiac related and need to be investigated seriously without physician bias.Objectives
To ensure that clinicians are cautious when evaluating older women with a history of depression who are presenting with atypical complaints.Case Report
A 61-year-old woman with history of depression presented to the Emergency Department with multiple complaints atypical for acute coronary syndrome. She had an immediate electrocardiogram and troponin-T Biosite point-of-care test (Biosite Incorporated, San Diego, CA) performed, which were positive for cardiac ischemia and myocardial infarction. The patient underwent immediate cardiac catheterization, which revealed occlusion of the mid left circumflex. After aspiration of thrombus and balloon dilatation of the site, a bare metal stent was deployed, restoring excellent flow. The patient did well medically but her depression worsened after the procedure and continues despite psychiatric intervention.Conclusion
For years there have been gender differences in medical treatment of coronary artery disease, and often women’s complaints are not investigated aggressively. Post-menopausal women are at great risk for cardiac ischemia and depression, and their symptoms, which are often atypical, may not be diagnosed as anginal equivalents. In addition, depression is an independent risk factor for cardiovascular disease and, if it occurs after myocardial infarction, may lead to poor quality of life and increased morbidity and mortality. Patients who have had a coronary event must be thoroughly evaluated for signs of depression and receive the necessary treatment. 相似文献18.
Background
Patients affected by acute coronary syndrome (ACS) report several symptoms subsequent to their discharge from hospital. These symptoms prolong their sick leave and complicate their return to the normal activities of everyday life. To improve health outcomes and establish quicker recovery for these patients, there is a need to better understand patients’ perceptions of their illness.Objective
To explore patients’ experiences of ACS during their hospital stay.Design
A qualitative interpretative interview study was conducted among patients during their hospitalization for ACS.Setting
The study was performed in two designated coronary care units at a hospital in Sweden.Participants
Twelve participants (five women and seven men; age range, 45–72 years), hospitalized with a diagnosis of ACS, were included in this study.Methods
Patient narratives were recorded and transcribed. The records were later analyzed using a phenomenological hermeneutic approach.Results
Patient experiences of ACS were formulated into one main theme: “awareness that life is lived forwards and understood backwards”. Two minor themes predominated in this main theme. The first was a sense of “struggling to manage the acute overwhelming phase”, which included four sub-themes: onset of life-threatening symptoms; fear and anxiety; being taken by surprise; and experiencing life as a hazardous adventure. The second theme was “striving to obtain a sense of inner security”, which also included four sub-themes: searching for and processing the cause and its explanation; maintaining a personal explanation; dealing with concern and uncertainty; and having a readiness to negotiate with life-pattern activities.Conclusions
Hospitalized patients affected by ACS consider the cause of the onset and prepare to optimize their future health. These patients construct personal models to explain their disease, which may persist throughout continuum of care. One way to improve health outcomes for patients with ACS is to establish a shared knowledge about the illness and formulate personal care plans that cover the hospital stay as well as possibly extending into primary care after discharge, based on the patients’ point of view. 相似文献19.
Emilie Bohyn Elophe Dubie Claire Lebrun Jérôme Jund Gaspard Beaune Patrick Lesage Loïc Belle Dominique Savary 《The American journal of emergency medicine》2014
Background
High-sensitivity troponin (HS-TnT) combined with copeptin have been proposed to expedite the diagnostic exclusion of acute myocardial infarction. The Global Registry of Acute Coronary Events (GRACE) has been validated and recommended by the European Society of Cardiology as a prognostic score in the management of acute coronary syndrome (ACS) without ST-segment elevation (non-ST +) on the electrocardiogram. Our study examined whether a low GRACE score (< 108) combined with negative HS-TnT (< 14 ng/L) and copeptin (< 14 pmol/L) reliably exclude the diagnosis of non-ST + ACS, including non–ST-segment elevation myocardial infarction and unstable angina.Methods
This observational, prospective study included patients presenting with chest pain lasting < 6 hours, consistent with non-ST + ACS. Blood was collected early for measurements of copeptin and HS-TnT. The negative predictive value of combined copeptin, HS-TnT, and GRACE score was calculated in the diagnosis of non-ST + ACS. The thresholds of positivity were 14 ng/L for HS-TnT, 14 pmol/L for copeptin and 108 for the GRACE score.Results
Among 247 patients retained in the analysis, the diagnosis of ACS was made in 50 (20.4%), including 39 non–ST-segment elevation myocardial infarction and 11 unstable angina. The negative predictive value of combined HS-TnT, copeptin and GRACE score was 99%.Conclusion
A negative copeptin associated with a negative HS-TnT in a patient presenting with a low GRACE score expedited the diagnostic exclusion of non-ST + ACS. 相似文献20.
The new Vancouver Chest Pain Rule using troponin as the only biomarker: an external validation study
Louise Cullen Jaimi H. Greenslade Martin Than Anthony F.T. Brown Christopher J. Hammett Arvin Lamanna Dylan F. Flaws Kevin Chu Lindsay F. Fowles William A. Parsonage 《The American journal of emergency medicine》2014