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11.
12.
Can Electrocardiographic Criteria Predict Adverse Cardiac Events and Positive Cardiac Markers? 总被引:5,自引:0,他引:5
Andra L. Blomkalns MD Christopher J. Lindsell PhD Abhinav Chandra MD Mary E. Osterlund MD W. Brian Gibler MD Charles V. Pollack MS MD Brian R. Tiffany MD PhD Judd E. Hollander MD James W. Hoekstra MD 《Academic emergency medicine》2003,10(3):205-210
OBJECTIVES: To determine electrocardiogram (ECG) predictors of positive cardiac markers and short-term adverse cardiac events in an undifferentiated chest pain population presenting to emergency departments (EDs). The authors hypothesized that specific ECG findings, other than those previously identified in higher-risk populations, would be predictive of cardiac outcomes and positive cardiac markers. METHODS: This study used data from a prospectively collected, retrospectively analyzed Internet-based data registry of undifferentiated chest pain patients (i*trACS). Logistic regression modeling was performed to determine the ECG findings that were predictive of 1) positive cardiac markers and 2) short-term adverse cardiac events. RESULTS: ST-segment elevation (STE), ST-segment depression (STD), pathological Q-waves (PQW), and T-wave inversion were associated with increased odds of percutaneous coronary intervention or catheterization, myocardial infarction, or coronary artery bypass grafting. The odds of creatine kinase-MB (CK-MB) measuring positive were increased if STE, STD, or PQW were present [odds ratio (OR) 2.495, 2.582, and 1.295, respectively]. A right bundle branch block tended to decrease the odds of CK-MB measuring positive (OR 0.658). A similar pattern of results was observed for troponin I (OR 3.608 for STE, 3.72 for STD, 1.538 for PQW). Troponin T showed an increased odds of measuring positive if any of STE, STD, left bundle branch block, or T-wave inversion were evident (OR 2.313, 2.816, 1.80, and 1.449, respectively). CONCLUSIONS: Initial ECG criteria can be used to predict short-term cardiac outcomes and positive cardiac markers. These findings can be important aids in the risk-stratification and aggressive treatment regimens of chest pain patients presenting to EDs. 相似文献
13.
Michael C. Kontos Kristin L. Schmidt Michael McCue Louis F. Rossiter Michael Jurgensen Christopher S. Nicholson Robert L. Jesse Joseph P. Ornato James L. Tatum 《Journal of nuclear cardiology》2003,10(3):284-290
BACKGROUND: Our objective was to determine the cost-effectiveness of a comprehensive, risk-based triage system, composed of multiple critical pathways, with the use of early myocardial perfusion imaging (MPI) in low-risk patients. We found previously that a chest pain evaluation system that uses MPI in low-risk patients was safe and effective, but the cost-effectiveness of this approach was not studied. METHODS AND RESULTS: We compared two groups. The Acute Cardiac Team (ACT) group (n = 874) was assigned prospectively to 1 of 4 risk levels by emergency department (ED) physicians. Level 1, 2, and 3 patients were admitted; level 4 patients were evaluated in the ED. Level 3 and 4 patients underwent ED MPI. The control group (n = 713) represented consecutive patients evaluated in the prior year according to standard care and assigned retrospectively to an ACT level based on the presenting electrocardiographic and clinical data. Record and hospital administrative data were assessed for clinical variables, outcomes, lengths of stay, and all expenses incurred within 30 days of the index visit. The baseline characteristics of the two groups were similar, including age, sex, myocardial infarction prevalence, and 30-day revascularization rates within each level or between the two groups. Mean costs per encounter were reduced for the ACT patients for each level, which was significant when all patients were compared ($5,030 +/- $7,081 vs $6,044 +/- $10,432, P =.02). Use of MPI in the low-risk patients was associated with reduced costs (level 3, $4,958 +/- $4,948 vs $5,051 +/- $7,036; level 4, $1,529 +/- $2,664 vs $1,794 +/- $6,854) and was associated with a significantly lower angiography rate and shorter length of stay. CONCLUSIONS: Implementation of a comprehensive strategy for chest pain evaluation and triage reduced overall costs for patients with chest pain on presentation. Acute MPI in the ED setting did not increase net cost. 相似文献
14.
Risk of death from acute pancreatitis 总被引:5,自引:0,他引:5
Giorgio Talamini Claudio Bassi Massimo Falconi Nora Sartori Luca Frulloni Vincenzo Di Francesco Sergio Vesentini Paolo Pederzoli Giorgio Cavallini 《Journal of gastrointestinal cancer》1996,19(1):15-24
Summary
Conclusions
The analysis of all the data available in 192 patients at 24 h from admission shows that only serum glucose above 250 mg/dL
(13.88 mmol/L) and serum creatinine above 2 mg/dL (176.8 μmol/L) are prognostic factors of death (P<0.0001). When, however, pathological chest X-rays are also considered in a subset of 149 patients, these and serum creatinine
are prognostic factors of death with odds ratios of 2.9 (95% CL 1.3–6.3) and 9.4 (95% CL 2.2–40.7), respectively (P<0.0001).
Background In patients suffering from acute pancreatitis, neither Ranson scores nor Glasgow criteria evaluation at 24 h yield a sufficiently
reliable prognosis of the risk of death from the first acute attack.
Methods After excluding posttraumatic, postsurgical, and post-ERCP acute pancreatitis, we selected 192 consecutive patients admitted
in the first instance to our center for a first attack, distinguishing between patients who died and patients who survived.
We used Cox's model to analyze the prognostic weight of variables available within 24 h of admission (sex, age, alcohol intake,
smoking habits, 17 biochemical tests, body mass index, chest X-rays, body temperature, and shock status).
Results Seventeen (8.8%) patients died; mortality showed a decreasing trend over the period of years considered and was correlated,
among other things, with necrotizing type of pancreatitis, idiopathic etiology, and shock status on admission. 相似文献
15.
Localized pleural plaques and lung cancer. 总被引:1,自引:0,他引:1
T Partanen M Nurminen A Zitting H Koskinen M Wiikeri K Ahlman 《American journal of industrial medicine》1992,22(2):185-192
In a mass chest radiography survey conducted in 1971 for 7,986 residents of three Finnish communities, 604 subjects (7.6%) with pleural plaques but not other asbestos-related radiographic signs were identified. The same number of referents, each individually matched to each plaque carrier on sex, birth year, and community, was selected from among persons in the same source population with no pleural plaques. The two groups were followed for investigation of incidence of lung cancer during 1972-1989. Twenty-eight of those with plaques and 25 referents contracted lung cancer (crude conditional RR = 1.1; CL95 = 0.7, 1.9). The application of the proportional hazards model, with adjustment for sex, age, and residence, resulted in a hazard ratio of 1.1 (CL = 0.6, 1.8). The risk ratio estimate may be biased; hence, the result is inconclusive in regard to the predictive assessment of lung cancer risk among carriers of pleural plaques. 相似文献
16.
17.
Chest Wall Implants: Their Use for Pectus Excavatum,Pectoralis Muscle Tears,Poland's Syndrome,and Muscular Insufficiency 总被引:3,自引:3,他引:0
Darryl J. Hodgkinson 《Aesthetic plastic surgery》1997,21(1):7-15
Solid customized and prefabricated silicone implants have been used by the author for 15 years in a wide range of chest wall
deformities. Chest wall implants are often used in males seeking to augment a muscularly deficient or underdeveloped chest;
however, their greatest use has come in a variety of deformities both congenital and acquired, such as pectus excavatum, Poland's
Syndrome, and pectoralis muscle tears. The implants can be either customized using a moulage technique or are prefabricated,
manufactured implants which can be modified on the operating table to repair the contour deformity. The immediate postoperative
problem of seroma and subcutaneous implant ``show' has been minimized by careful planning, gentle technique, deep insertion,
improved patient positioning on the operating room table, and the use of oral anti-inflammatory medications. The long-term
results of these implants seem very satisfactory. The patients are usualy physically active, and the implants show no long-term
sequelae such as seroma, infection, displacement, or rupture. 相似文献
18.
多平面重建对支气管血管连接引起肿瘤切迹的检出 总被引:4,自引:2,他引:2
目的 从病理角度认识支气管血管切迹征 ,探讨多平面重建 (MPR)对该征检出的作用。方法 ①观察病理证实的周围型小肺癌 91例 ,良性结节 5 5例。以及 9例周围型小肺癌 ,2例良性结节术后改良Heitzman法充气固定肺叶制成病理大切片 ,对良恶性支气管血管连接进行对比分析。②对恶性支气管血管连接 2 0例 ,良性 13例行MPR ,考察MPR显示切迹征的作用。结果 ①支气管血管切迹征对恶性者特异性为 95 .2 %。②恶性支气管血管连接在MPR的切迹征检出率为 70 % ,与横断扫描之间有显著差异。结论 切迹征对于恶性支气管血管连接有高特异性诊断价值。MPR配合多层螺旋CT能提高此征检出率 相似文献
19.
目的:探讨和鉴别心电图短P-R间期的产生原因,为临床诊断、治疗提供依据。方法:检测115例受检者的常规导联心电图(RLECG)、头胸导联心电图(HCECG)、食管导联心电图(ELECG),对其中55例临床可疑心律失常和RLECG示短P-R间期者行食管心房调搏电生理检查。结果:①P波出现率和振幅均值比较ELECG>HCECG>RLECG(P<0.01),出现率分别为100%、95%、91%。②HCECGP-R段均值(P<0.01)及变异系数<RLECG。③RLECG波幅低、图形多变是产生心电图短P-R间期的主要原因。结论:作为无创伤性检查方法,HCECG和ELECG可以对短P-R间期者进行初步筛选,而经食管心房调搏能检测ECG短P-R间期的电生理特性,对鉴别诊断有肯定价值。 相似文献
20.
Philip J. Bossart M.D. F.A.C.E.P. Lenard Brunsdale M.D. Matt Hughes M.D. B. J. Manaster M.D. Ph.D. Anthony Doyle M.D. Kathy Murray M.D. David Tripp Ph.D. 《Emergency radiology》1997,4(1):26-29
To determine the utility of the lateral view of the chest in emergency department patients, records of all patients who had had 2-view chest x-rays ordered in the emergency department were reviewed retrospectively. A study radiologist recorded a reading of the posteroanterior (PA) radiograph alone. The lateral radiograph was then provided, along with the PA view, and a second reading was recorded. A comparison was then made between the first and second readings.A total of 417 sets of x-rays were included. The PA view alone successfully diagnosed or suspected 92% of pulmonary nodules, 95% of effusions, 97% of cases of emphysema, 98% of pneumonias, and 100% of cases of cardiomegaly, pulmonary edema, interstitial pulmonary disease, and atelectasis.In the emergency department patient population, lateral views of the chest have minimal diagnostic yield and therefore may be used selectively to safely decrease the amount of breast radiation exposure to young women. 相似文献