Abstract:
STUDY OBJECTIVE:Coronary computed tomographic (CT) angiography has excellent performance characteristics relative to coronary angiography and exercise or pharmacologic stress testing. We hypothesize that coronary CT angiography can identify a cohort of emergency department (ED) patients with a potential acute coronary syndrome who can be safely discharged with a less than 1% risk of 30-day cardiovascular death or nonfatal myocardial infarction. METHODS:We conducted a prospective cohort study at an urban university hospital ED that enrolled consecutive patients with potential acute coronary syndromes and a low TIMI risk score who presented to the ED with symptoms suggestive of a potential acute coronary syndrome and received a coronary CT angiography. Our intervention was either immediate coronary CT angiography in the ED or after a 9- to 12-hour observation period that included cardiac marker determinations, depending on time of day. The main clinical outcome was 30-day cardiovascular death or nonfatal myocardial infarction. RESULTS:Five hundred sixty-eight patients with potential acute coronary syndrome were evaluated: 285 of these received coronary CT angiography immediately in the ED and 283 received coronary CT angiography after a brief observation period. Four hundred seventy-six (84%) were discharged home after coronary CT angiography. During the 30-day follow-up period, no patients died of a cardiovascular event (0%; 95% confidence interval [CI] 0% to 0.8%) or sustained a nonfatal myocardial infarction (0%; 95% CI 0 to 0.8%). CONCLUSION:ED patients with symptoms concerning for a potential acute coronary syndrome with a low TIMI risk score and a nonischemic initial ECG result can be safely discharged home after a negative coronary CT angiography test result.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Hollander JE,Chang AM,Shofer FS,McCusker CM,Baxt WG,Litt HIdoi
10.1016/j.annemergmed.2008.09.025subject
Has Abstractpub_date
2009-03-01 00:00:00pages
295-304issue
3eissn
0196-0644issn
1097-6760pii
S0196-0644(08)01789-7journal_volume
53pub_type
杂志文章abstract:STUDY PURPOSE:To determine the ability of clinicians to predict the results of emergency head computed tomography (CT) scans. METHODS:Clinicians requesting cranial CT scans from the emergency department prospectively filled out a form detailing their patients' complaints, possible diagnoses, and the likelihood of find...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(94)70351-5
更新日期:1994-06-01 00:00:00
abstract::Creatine phosphokinase (CPK) and creatine kinase-MB (CK-MB) have been used extensively as diagnostic markers for myocardial infarction and skeletal muscle injury. Many factors affect the variability of serum CPK and serum CK-MB activity, especially physical activity. We discuss the influence of physical activity on mu...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(95)70270-9
更新日期:1995-04-01 00:00:00
abstract:STUDY OBJECTIVE:Scorpion envenomation is a common life-threatening hazard in tropical and subtropical countries. Standard treatment is not clearly defined. Many therapies, such as steroids, are prescribed without experimental justification. We sought to assess the efficacy of systematic administration of intravenous hy...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0196-0644(97)70105-7
更新日期:1997-07-01 00:00:00
abstract:STUDY OBJECTIVES:The health care needs of the elderly population are significantly different from those of younger patients and require special knowledge and skills on the part of emergency physicians. The purpose of this study was to identify the nature and extent of geriatric training currently provided to emergency ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81029-7
更新日期:1992-07-01 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:STUDY OBJECTIVE:We examine how dedicated methodology and statistical review affects the quality of manuscripts published in Annals of Emergency Medicine. DESIGN:The dedicated reviewers developed a manuscript scoring form based on previously used instruments. The form contained 84 unique elements. Eight items sought th...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2002.127328
更新日期:2002-09-01 00:00:00
abstract::The catatonic syndrome has a wide differential diagnosis that includes both psychiatric and organic disorders. We present the cases of two patients with catatonia seen acutely in the emergency department. In these cases, the striking clinical picture proved to be secondary to psychiatric disturbances, and were accompa...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(85)80105-0
更新日期:1985-04-01 00:00:00
abstract:STUDY OBJECTIVE:In patients presenting to the emergency department (ED) with an initial diagnostic impression of noncardiac chest pain, we determine the 30-day incidence of adverse cardiac events and characteristics associated with those events. METHODS:The multicenter, prospectively collected Internet Tracking Regist...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2004.03.021
更新日期:2004-12-01 00:00:00
abstract::A young woman presented with acute abdominal pain, anemia, and a positive pregnancy test. At surgery a large retroperitoneal hematoma secondary to a ruptured right kidney was found. Pathological examination revealed a hematogenic necrosis of a choriocarcinoma of the kidney. The patient tolerated subsequent chemotherap...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(87)80432-8
更新日期:1987-12-01 00:00:00
abstract:STUDY OBJECTIVE:We characterize the quantity and quality of data tables and figures in reports of randomized controlled trials (RCTs) submitted to the British Medical Journal (BMJ) and published in peer-reviewed journals. We investigate how the peer review process affected table and figure quality. METHODS:We reviewed...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2006.06.017
更新日期:2006-12-01 00:00:00
abstract::A survey completed by 265 emergency medical technicians (EMTs) who provide emergency prehospital care in a rural area included a stress inventory for health professionals and a job satisfaction scale. Logistic regression indicated that the 118 paid EMTs were more likely to be dissatisfied with the freedom they have on...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(87)80070-7
更新日期:1987-06-01 00:00:00
abstract:STUDY OBJECTIVE:The accurate diagnosis of influenza remains a diagnostic dilemma. We examine the performance of various strategies for diagnosing influenza infection in an unselected sample of adults during influenza season. METHODS:Consecutive adults presenting to a university emergency department or urgent care clin...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2005.05.020
更新日期:2005-11-01 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::Injury severity determination serves multiple purposes in trauma care systems by aiding prehospital triage, assisting clinical management, and facilitating outcome evaluation. Numerous authors have described methods for quantifying injury severity, most of which use physiologic status or anatomic injury. For prehospit...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(86)80936-2
更新日期:1986-12-01 00:00:00
abstract::This double-blind study compared the analgesic effects of morphine with those of butorphanol in patients who presented with pain because of sickle cell crisis. Patients were placed at bed rest, administered IV hydration, and randomly assigned on each visit to receive either 2 mg IM butorphanol or 6 mg IM morphine ever...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0196-0644(88)80554-7
更新日期:1988-08-01 00:00:00
abstract::We developed a cardiopulmonary resuscitation (CPR) message that can be given via telephone by emergency dispatchers directly to an individual reporting a cardiac arrest. The message was developed and evaluated on the basis of empirical observation of CPR performance of 203 community volunteers during simulated cardiac...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(84)80730-1
更新日期:1984-09-01 00:00:00
abstract::The case of a 28-year-old multiparous woman with an incarcerated gravid uterus is presented. This largely unknown entity invariably results in spontaneous abortion if untreated. Patients present with a characteristic and readily recognizable sign and symptom complex and ultrasonographic findings. Early diagnosis is em...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(87)80534-6
更新日期:1987-08-01 00:00:00
abstract:STUDY OBJECTIVES:To compare diagnostic strategies for the emergency assessment of patients with suspected acute thoracic aortic dissection and to measure the effect of delays related to the availability of these tests on the selection of the most appropriate one. METHODS:We carried out a decision analysis representing...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(96)70026-4
更新日期:1996-09-01 00:00:00
abstract:STUDY OBJECTIVE:Serum markers of smooth muscle destruction have been shown to be elevated in ectopic pregnancy, but they remain of questionable clinical utility. Our goal was to determine the clinical utility of 3 markers of smooth muscle destruction: creatine phosphokinase (CPK), smooth muscle heavy-chain myosin (SMHC...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2001.119851
更新日期:2001-12-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the public health impact of a hurricane on an inland area. DESIGN:Descriptive study. SETTING:Seven hospital emergency departments. PARTICIPANTS:Patients who were treated from September 22 to October 6, 1989, for an injury or illness related to Hurricane Hugo. INTERVENTION:None. MEASUREM...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(94)70307-8
更新日期:1994-04-01 00:00:00
abstract::We report the cases of two children with acute plastic fractures of the long bones following trauma. Bowing deformity was evident clinically and radiographically in both cases. The unique radiologic features consisted of absence of fracture lines and of periosteal new bone formation during the healing phase. The mecha...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(86)80997-0
更新日期:1986-05-01 00:00:00
abstract::This review synthesizes the existing literature to provide evidence-based predictions for the future of emergency care in the United States as a result of the Patient Protection and Affordable Care Act, with a focus on emergency department (ED) visit volume, acuity, and reimbursement. Patient behavior will likely be q...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/j.annemergmed.2015.04.007
更新日期:2015-11-01 00:00:00
abstract:STUDY OBJECTIVE:To be able to adhere to discharge instructions after a visit to the emergency department (ED), patients should understand both the care that they received and their discharge instructions. The objective of this study is to assess, at discharge, patients' comprehension of their ED care and instructions a...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2008.05.016
更新日期:2009-04-01 00:00:00
abstract:STUDY OBJECTIVES:To characterize the attendance at and presenters of conferences given to emergency medicine residents and to determine the ability of emergency medicine residents to attend conferences while working in the emergency department and on off-service rotations. DESIGN:Descriptive study of an anonymous mail...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(95)70288-1
更新日期:1995-03-01 00:00:00
abstract:STUDY OBJECTIVE:We describe and analyze the effectiveness and safety of etomidate for procedural sedation and evaluate the patient's perspective on effectiveness, side effects, and satisfaction. METHODS:We conducted an observational retrospective study of all patients who received etomidate for procedural sedation ove...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2002.123695
更新日期:2002-06-01 00:00:00
abstract::Ketamine produces rapid and consistent pediatric sedation with a predictable onset and recovery time. A wide margin of safety is afforded without the respiratory and cardiovascular depression commonly seen with alternative agents. The efficacy of ketamine is well established in anesthesia and dentistry and has extensi...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(05)82569-7
更新日期:1990-09-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the effect of different doses of the vasopressor angiotensin II on aortic diastolic and coronary perfusion pressures in a swine model of cardiac arrest. DESIGN:Immature swine were anesthetized and hemodynamically monitored. Ventricular fibrillation was induced; CPR was begun after ten minut...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)80213-6
更新日期:1993-02-01 00:00:00
abstract:STUDY OBJECTIVE:We evaluated the influence of home visiting on the risk for medically attended unintentional injury during home visiting (0 to 3 years) and subsequent to home visiting (3 to 5 years). METHODS:A retrospective, quasi-experimental study was conducted in a cohort of mother-child pairs in Hamilton County, O...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2017.01.029
更新日期:2017-09-01 00:00:00
abstract:STUDY OBJECTIVE:Peripheral intravenous catheters are the most common invasive device in health care yet have very high failure rates. We investigate whether the failure rate could be reduced by the addition of skin glue to standard peripheral intravenous catheter care. METHODS:We conducted a single-site, 2-arm, nonbli...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2015.11.026
更新日期:2016-08-01 00:00:00
abstract:STUDY OBJECTIVE:We describe and analyze a recent rapid deployment of disaster medical assistance teams and other government agencies to provide medical screening and anthrax prophylaxis to New York City US Postal Service employees potentially exposed to letters contaminated with anthrax spores. METHODS:A description o...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2003.105
更新日期:2003-04-01 00:00:00