Abstract:
STUDY OBJECTIVE:We evaluate associations between pairs of discordant cardiac biomarkers (positive MB band of creatine kinase [CKMB] with negative creatine kinase, positive CKMB with negative cardiac troponin, and positive troponin with negative CKMB) and the presence of acute coronary syndromes in emergency department (ED) chest pain patients. METHODS:This was a secondary analysis of a prospective registry. Data were obtained from the multicenter Internet Tracking Registry of Acute Coronary Syndromes, which included 17,713 ED visits for possible acute coronary syndrome between June 1999 and August 2001. First visits and first ED cardiac biomarker results from the 9 sites, 8 in the United States and 1 in Singapore, were included. Subjects were excluded for incomplete information or an initial ECG consistent with ST-segment elevation myocardial infarction. Acute coronary syndrome was defined by diagnosis-related group code indicating myocardial infarction, positive invasive or noninvasive diagnostic testing, revascularization, or death during hospitalization or within 30 days. RESULTS:Of 8,769 eligible patients, 1,614 (18.4%) had acute coronary syndrome. The CKMB and cardiac troponin results were discordant in 7% of patients (CKMB+/cardiac troponin-, 4.9%, CKMB-/cardiac troponin+ 2.1%), whereas increased CKMB with normal creatine kinase levels occurred in 239 (3.1%) patients. The unadjusted odds ratios with 95% confidence intervals for acute coronary syndrome in patients with and without discordant markers were: CKMB+/CK- 5.7 (4.4-7.4), CKMB+/CK+ 4.4 (3.6-5.2), CKMB-/cTn+ 4.8 (3.4-6.8), CKMB+/cTn- 2.2 (1.7-2.8), CKMB+/cTn+ 26.6 (18.0-39.3). For the group with cardiac troponin, the reference category was negative troponin and negative CKMB; for the group with creatine kinase, the reference category was negative CKMB but either a positive or negative creatine kinase. CONCLUSION:Among the spectrum of ED patients with chest pain, an increased CKMB level with a normal creatine kinase level identifies patients at increased risk for acute coronary syndrome. Similarly, an increased troponin level regardless of CKMB level and an increased CKMB level regardless of troponin level identify patients at higher risk for acute coronary syndrome than those with uniformly normal cardiac biomarker levels. Our data suggest that discordant cardiac biomarkers may identify patients at increased risk for acute coronary syndrome.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Storrow AB,Lindsell CJ,Han JH,Slovis CM,Miller KF,Gibler WB,Hoekstra JW,Peacock WF,Hollander JE,Pollack CV Jr,EMCREG-i*trACS Investigators.doi
10.1016/j.annemergmed.2006.05.016subject
Has Abstractpub_date
2006-12-01 00:00:00pages
660-5issue
6eissn
0196-0644issn
1097-6760pii
S0196-0644(06)00701-3journal_volume
48pub_type
杂志文章abstract::We present the case of a patient who presented with persistent hiccups induced by a hair irritating the tympanic membrane and activating the vagally mediated hiccup neural reflex arc. Commonly identified etiologies and treatments of this condition are then reviewed. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(82)80009-7
更新日期:1982-01-01 00:00:00
abstract::In 1976 an independent department was established for the emergency treatment of patients in the county hospital in Szolnok, Hungary. The new system changed the traditional structure of patient flow and the work plan of other departments, and it influenced the curing and nursing activities of the departments. The reor...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(80)80113-2
更新日期:1980-07-01 00:00:00
abstract:STUDY OBJECTIVE:Availability of timely follow-up care is essential in emergency medicine. We describe nonprice barriers to care experienced by callers reporting to be emergency department (ED) patients in need of follow-up care. METHODS:This was a secondary analysis of data collected during a survey of ambulatory clin...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2007.10.027
更新日期:2008-05-01 00:00:00
abstract:STUDY OBJECTIVE:To describe the experience of croup at Princess Margaret Hospital for Children (PMH), the only tertiary pediatric hospital in Western Australia, from 1980 through 1995 with reference to the introduction of routine steroid treatment in the ICU in 1989, in the general hospital wards from 1989 through 1993...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(96)70084-7
更新日期:1996-12-01 00:00:00
abstract::After recent terrorist attacks, new attention has been focused on health care facility decontamination practices. This article reviews core issues related to the selection of appropriate personal protective equipment for health care facility decontamination personnel, with an emphasis on respiratory protection. Existi...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(03)00447-5
更新日期:2003-09-01 00:00:00
abstract:STUDY OBJECTIVE:Previous studies have demonstrated that a sex disparity exists in the editorial boards of select specialties. However, there are limited data with respect to emergency medicine. We seek to determine the sex distribution of editors in chief and editorial board members among emergency medicine journals. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2020.03.027
更新日期:2021-01-01 00:00:00
abstract::Management of snake venom poisoning with antivenin has been the time-proven and medically accepted standard in virtually every country, including the United States. All antivenins are equine in source, and administration to patients exposes them to all the adverse effects of heterologous antisera. The purity and speci...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(87)80737-0
更新日期:1987-09-01 00:00:00
abstract::When the abdomen is compressed manually in counterpoint to the rhythm of chest compression, in the performance of interposed abdominal compression-CPR, artificial circulation is approximately doubled in animal experiments and in electronic models of the circulatory system. These studies suggest that external manual co...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)80245-8
更新日期:1993-01-01 00:00:00
abstract:STUDY OBJECTIVE:Advanced, out-of-hospital procedures such as intravenous access are commonly performed by emergency medical services (EMS) personnel, yet little evidence supports their use among noninjured patients. We evaluate the association between out-of-hospital, intravenous access and mortality among noninjured, ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2011.07.021
更新日期:2012-04-01 00:00:00
abstract::To evaluate the heat burden in parked cars, a study was done to measure inside car temperatures in different situations. A large car and a small car were parked in direct sunlight and in shade. In direct sun, the highest temperatures recorded in the small and large cars were 78 C and 65 C, respectively. The highest te...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(82)80097-8
更新日期:1982-05-01 00:00:00
abstract:STUDY OBJECTIVE:We examine whether a specific educational effort reduces emergency department violence in the short term and quantify the amount of violence in the ED. METHODS:Cross-sectional prospective surveys were conducted at a tertiary referral center at baseline (1998) and at 3 and 6 months (1999) after the Prev...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2002.121202
更新日期:2002-01-01 00:00:00
abstract:STUDY OBJECTIVE:To determine whether physicians blinded to the serum potassium level can predict hyperkalemia (potassium concentration of more than 5.0 mmol/L) from the ECG. DESIGN:ECGs of patients at high risk for hyperkalemia were interpreted retrospectively by two physicians blinded not only to the specific clinica...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81476-3
更新日期:1991-11-01 00:00:00
abstract:STUDY OBJECTIVE:We present our experience with a novel technique for the reduction of acute hip dislocation in the emergency department (ED). METHODS:We searched the medical records of all patients with a hip dislocation treated in our ED during a 4-year period. We recorded patient demographics, reduction technique, o...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2011.07.010
更新日期:2011-12-01 00:00:00
abstract::As we mark the 25th anniversary of the clinical application of closed-chest cardiopulmonary resuscitation (SCPR), it is time to look back and analyze the progress we have made in the resuscitation of sudden death syndrome. Recent studies of SCPR's effectiveness have yielded mixed results, in comparison to early studie...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(85)80052-4
更新日期:1985-08-01 00:00:00
abstract::Recent interest in civilian trauma as a public health problem dates from the National Academy of Sciences white paper in 1966. Civilian trauma patterns vary depending on locale--blunt trauma predominates in rural and smaller urban areas (65% to 80% of hospital admissions); penetrating trauma in larger urban areas outw...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(86)80921-0
更新日期:1986-12-01 00:00:00
abstract:STUDY OBJECTIVE:We sought to evaluate the methods and accuracy of mortality data collection and summarize the injury mortality rate in one sector of the State of Olancho, Honduras, with the intent to establish a baseline of injury mortality that will identify potential areas of intervention and serve as a comparison af...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2000.109444
更新日期:2000-10-01 00:00:00
abstract:STUDY OBJECTIVE:Methanol poisoning outbreaks are a global public health issue, with delayed treatment causing poor outcomes. Out-of-hospital ethanol administration may improve outcome, but the difficulty of conducting research in outbreaks has meant that its effects have never been assessed. We study the effect of out-...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2016.01.010
更新日期:2016-07-01 00:00:00
abstract:STUDY OBJECTIVE:Previous studies have indicated a number of barriers to screening for domestic violence (DV) in an emergency department setting. These barriers result in inconsistencies which determine who is screened as well as the content and quality of the information obtained, and if uncontrolled they are likely to...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(98)70260-4
更新日期:1998-04-01 00:00:00
abstract:STUDY OBJECTIVE:We explore what emergency physicians with access to health information exchange have to say about it and strive to better understand the factors affecting their use of it. METHODS:A qualitative study using grounded theory principles was conducted in 4 urban emergency departments that had health informa...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/j.annemergmed.2013.09.024
更新日期:2014-03-01 00:00:00
abstract::A mathematical model for tissue thermodilution was developed to study cerebral cortical perfusion before and after controlled perfusion arrest. Cerebral cortical perfusion rates are readily determined by this method. A thermistor was introduced into the subdural space and secured in direct contact with the frontal cor...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(83)80123-1
更新日期:1983-01-01 00:00:00
abstract::The development of an organized filing system for referencing articles pertinent to emergency medicine is presented. This simple and flexible system allows for modification for the individual needs of the emergency physician. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(80)80306-4
更新日期:1980-09-01 00:00:00
abstract::The deleterious effects of night shift work are discussed in relation to emergency physicians. Much of the early research is drawn from heavy industry sources and must be extrapolated to medical work. Disruption of circadian rhythms and Zeitgebers, caused by adherence to contemporary social schedules, causes recurrent...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(84)80615-0
更新日期:1984-03-01 00:00:00
abstract::The American Board of Emergency Medicine gathers extensive background information on emergency medicine residents and the programs in which they train. We present the third annual report on the status of US emergency medicine residency programs. [American Board of Emergency Medicine. Report of the Task Force on Reside...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2000.106388
更新日期:2000-05-01 00:00:00
abstract:STUDY OBJECTIVE:To develop clinical rules for the safe and effective use of flumazenil in suspected benzodiazepine overdose. METHODS:We assembled a retrospective series of 35 consecutive comatose patients admitted between October 1992 and July 1993 to a toxicologic ICU with the presumptive diagnosis of drug overdose. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(96)70191-9
更新日期:1996-06-01 00:00:00
abstract::Extraordinary incidents resulting in airborne infectious disease outbreaks could produce patient isolation requirements that exceed most hospitals' capacity. This article investigates expedient methods to establish airborne infection isolation areas using a commercially available portable filtration unit and common ha...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2004.07.451
更新日期:2004-12-01 00:00:00
abstract:STUDY OBJECTIVE:We determine the association between use of specific cephalosporins and macrolides and hospital length of stay in patients with sickle cell disease (SCD) who are admitted with acute chest syndrome, and determine treatment risk factors for acute chest syndrome-related 30-day readmission. METHODS:Patient...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2020.08.011
更新日期:2020-09-01 00:00:00
abstract::During a 3-month period, a 33-year-old man presented to the emergency department on 4 occasions with dyspnea, palpitations, and syncope. His initial presentation was accompanied by acute myocardial injury and ventricular fibrillation. An extensive evaluation spanned the 3 months and included echocardiography, cardiac ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2005.02.002
更新日期:2005-06-01 00:00:00
abstract:STUDY OBJECTIVE:Midazolam is widely used for procedural sedation and analgesia. Etomidate has been studied mostly in adults. Our objective is to compare the efficacy of etomidate and midazolam for achieving procedural sedation and analgesia in children. METHODS:A randomized, double-blind, emergency department and orth...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2006.03.004
更新日期:2006-10-01 00:00:00
abstract::The sudden emergence of 2009 H1N1 influenza in the spring of that year sparked a surge in visits to emergency departments in New York City and other communities. A larger, second wave of cases was anticipated the following autumn. To reduce a potential surge of health system utilization without denying needed care, we...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2010.04.005
更新日期:2010-09-01 00:00:00
abstract:STUDY OBJECTIVES:To determine the availability and use of premixed activated charcoal in sorbitol preparations during multiple-dose activated charcoal therapy in the emergency department. DESIGN AND SETTING:A prospective telephone survey of all 911 receiving hospitals within the catchment area of one poison center. T...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)80406-8
更新日期:1993-12-01 00:00:00