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north american chest pain rule

Somayeh Valadkhani, Mohammad Jalili, Elham Hesari, Hadi Mirfazaelian
INTRODUCTION: Acute coronary syndrome accounts for more than 15% of the chest pains. Recently, Hess et al. developed North American Chest Pain Rule (NACPR) to identify very low-risk patients who can be safely discharged from emergency department (ED). The present study aimed to validate this rule in EDs of two academic hospitals. METHODS: A prospective diagnostic accuracy study was conducted on consecutive patients 24 years of age and older presenting to the ED with the chief complaint of acute chest pain, during March 2013 to June 2013...
2017: Emergency (Tehran, Iran)
Brit Long, Alex Koyfman
BACKGROUND: Chest pain accounts for 10% of emergency department (ED) visits annually, and many of these patients are admitted because of potentially life-threatening conditions. A substantial percentage of patients with chest pain are at low risk for a major cardiac adverse event (MACE). OBJECTIVE: We investigated controversies in the evaluation of patients with low-risk chest pain, including clinical scores, decision pathways, and shared decision-making. DISCUSSION: ED patients with chest pain who have negative biomarker results and nonischemic electrocardiograms are at low risk for MACE...
January 2017: Journal of Emergency Medicine
Dylan Flaws, Martin Than, Frank Xavier Scheuermeyer, James Christenson, Barbara Boychuk, Jaimi H Greenslade, Sally Aldous, Christopher J Hammett, William A Parsonage, Joanne M Deely, John W Pickering, Louise Cullen
OBJECTIVE: The emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP) facilitates low-risk ED chest pain patients early to outpatient investigation. We aimed to validate this rule in a North American population. METHODS: We performed a retrospective validation of the EDACS-ADP using 763 chest pain patients who presented to St Paul's Hospital, Vancouver, Canada, between June 2000 and January 2003. Patients were classified as low risk if they had an EDACS <16, no new ischaemia on ECG and non-elevated serial 0-hour and 2-hour cardiac troponin concentrations...
September 2016: Emergency Medicine Journal: EMJ
Simon A Mahler, Chadwick D Miller, Harold I Litt, Constantine A Gatsonis, Bradley S Snyder, Judd E Hollander
OBJECTIVES: The 2-hour accelerated diagnostic protocol (ADAPT) is a decision rule designed to identify emergency department (ED) patients with chest pain for early discharge. Previous studies in the Asia-Pacific region demonstrated high sensitivity (97.9% to 99.7%) for major adverse cardiac events (MACE) at 30 days. The objective of this study was to determine the validity of ADAPT for risk stratification in a cohort of U.S. ED patients with suspected acute coronary syndrome (ACS). METHODS: A secondary analysis of participants enrolled in the American College of Radiology Imaging Network (ACRIN) PA 4005 trial was conducted...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Nitesh Jain, Aman Sethi, Hasnain Bawaadam, Nisha Jain, Puja Sethi, Fazila Barodawala, Fauzia Wani, Kovid Trivedi, Anjali Shinde, Sivashankar Sivaraman
SESSION TYPE: Cancer Case Report Posters IPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: IMT is a distinctive mesenchymal neoplasm of the lung of uncommon occurrence.CASE PRESENTATION: A 36 year old African American female presented with subacute right anterior chest pain, productive cough, and 30 pound weight loss. Chest radiograph (CXR) and Computed tomography (CT) of the chest with contrast showed right upper lobe (RUL) infiltrate. CT chest ruled out pulmonary embolism. A course of antibiotics followed with no improvement in either symptoms or radiographic findings...
October 1, 2012: Chest
Anwar Dayan Osborne, Karim Ali, Douglas Lowery-North, James Capes, Matthew Keadey, Nicole Franks, Vicki Hertzberg, Ryan Stroder, Stephen Pitts, Matthew Wheatley, Rachel O'Malley, George Leach, Michael Ross
BACKGROUND: : The American College of Cardiology/American Heart Association guidelines for ST-elevation myocardial infarction state that an electrocardiogram (ECG) should be performed on patients with suspected acute coronary syndrome upon presentation to the emergency department (ED) within 10 minutes. OBJECTIVE: : To determine how previously published clinical criteria for obtaining an ECG at ED triage perform in a population of patients receiving emergency cardiac catheterization for suspected myocardial infarction...
December 2012: Critical Pathways in Cardiology
Simon A Mahler, Chadwick D Miller, Judd E Hollander, John T Nagurney, Robert Birkhahn, Adam J Singer, Nathan I Shapiro, Ted Glynn, Richard Nowak, Basmah Safdar, Mary Peberdy, Francis L Counselman, Abhinav Chandra, Joshua Kosowsky, James Neuenschwander, Jon W Schrock, Stephen Plantholt, Deborah B Diercks, W Frank Peacock
BACKGROUND: The HEART score and North American Chest Pain Rule (NACPR) are decision rules designed to identify acute chest pain patients for early discharge without stress testing or cardiac imaging. This study compares the clinical utility of these decision rules combined with serial troponin determinations. METHODS AND RESULTS: A secondary analysis was conducted of 1005 participants in the Myeloperoxidase In the Diagnosis of Acute coronary syndromes Study (MIDAS)...
September 30, 2013: International Journal of Cardiology
Erik P Hess, George A Wells, Allan Jaffe, Ian G Stiell
BACKGROUND: Chest pain is the second most common chief complaint in North American emergency departments. Data from the U.S. suggest that 2.1% of patients with acute myocardial infarction and 2.3% of patients with unstable angina are misdiagnosed, with slightly higher rates reported in a recent Canadian study (4.6% and 6.4%, respectively). Information obtained from the history, 12-lead ECG, and a single set of cardiac enzymes is unable to identify patients who are safe for early discharge with sufficient sensitivity...
2008: BMC Emergency Medicine
E B Sgarbossa, S L Pinski, A Barbagelata, D A Underwood, K B Gates, E J Topol, R M Califf, G S Wagner
BACKGROUND: The presence of left bundle-branch block on the electrocardiogram may conceal the changes of acute myocardial infarction, which can delay both its recognition and treatment. We tested electrocardiographic criteria for the diagnosis of acute infarction in the presence of left bundle-branch block. METHODS: The base-line electrocardiograms of patients enrolled in the GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) trial who had left bundle-branch block and acute myocardial infarction confirmed by enzyme studies were blindly compared with the electrocardiograms of control patients who had chronic coronary artery disease and left bundle-branch block...
February 22, 1996: New England Journal of Medicine
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