Coronary computed tomographic angiography for rapid discharge of low-risk patients with potential acute coronary syndromes.


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.


Ann Emerg Med


Hollander JE,Chang AM,Shofer FS,McCusker CM,Baxt WG,Litt HI




Has Abstract


2009-03-01 00:00:00














  • Response of consultants to the emergency department: a preliminary report.

    abstract:STUDY OBJECTIVE:To determine the timeliness of response of consultants called to evaluate patients in the emergency department of a community hospital. METHODS:Consultation requests from an ED located in a medium-sized community hospital were studied for a 1-month period. Data collected included name and specialty of ...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Vosk A

    更新日期:1998-11-01 00:00:00

  • Rapid-sequence intubation of the pediatric patient. Pediatric Emergency Medicine Committee of the American College of Emergency Physicians.

    abstract::Airway compromise is the most common cause of death and severe morbidity in acutely ill and injured children. Rapid-sequence intubation (RSI) is a technique for emergency airway control designed to maximize successful endotracheal intubation while minimizing the adverse physiologic effects of this procedure. RSI requi...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章,评审


    authors: Gerardi MJ,Sacchetti AD,Cantor RM,Santamaria JP,Gausche M,Lucid W,Foltin GL

    更新日期:1996-07-01 00:00:00

  • Reversible diaphragmatic eventration following chest tube thoracostomy.

    abstract::This report describes a case of acquired eventration of a hemidiaphragm after insertion of a chest tube for treatment of an iatrogenic pneumothorax. Partial withdrawal of the chest tube resulted in immediate return of the hemidiaphragm to its original position. This is believed to be the first report of the resolution...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章,评审


    authors: Salon JE

    更新日期:1995-04-01 00:00:00

  • Derivation of a decision rule for the use of radiography in acute knee injuries.

    abstract:STUDY OBJECTIVE:To derive a highly sensitive decision rule for the selective use of radiography in acute knee injuries. DESIGN:Prospectively administered survey. SETTING:Emergency departments of two university hospitals. PARTICIPANTS:Convenience sample of 1,047 adults with acute knee injuries. RESULTS:Attending eme...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Stiell IG,Greenberg GH,Wells GA,McKnight RD,Cwinn AA,Cacciotti T,McDowell I,Smith NA

    更新日期:1995-10-01 00:00:00

  • Outcome of patients experiencing cardiac arrest with carbon monoxide poisoning treated with hyperbaric oxygen.

    abstract:STUDY OBJECTIVE:We sought to examine the outcome of a subgroup of patients with extreme carbon monoxide (CO) poisoning, specifically those discovered in cardiac arrest, resuscitated, and subsequently treated with hyperbaric oxygen (HBO(2)). Opinions of hyperbaric medicine physicians regarding the treatment of such pati...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Hampson NB,Zmaeff JL

    更新日期:2001-07-01 00:00:00

  • Significance of symptoms and signs in patients with traumatic aortic rupture.

    abstract::The records of 50 patients with traumatic aortic rupture (Group I) and 50 patients with blunt chest trauma but negative aortograms (Group II) were reviewed retrospectively. Symptoms and signs referable to the chest and thoracic aorta were recorded and compared in Group I and Group II patients. Each patient's chart was...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Sturm JT,Perry JF Jr,Olson FR,Cicero JJ

    更新日期:1984-10-01 00:00:00

  • Analysis of pediatric hospitalizations after emergency department release as a quality improvement tool.

    abstract:STUDY OBJECTIVE:We characterize repeat pediatric emergency department visits and determine the cause for such visits as an indicator of potential need for quality improvement. We hypothesized that most repeat ED visits resulting in hospitalization do not represent medical errors. METHODS:The study was performed at a l...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Depiero AD,Ochsenschlager DW,Chamberlain JM

    更新日期:2002-02-01 00:00:00

  • N-acetylcysteine reduces methemoglobin in vitro.

    abstract:STUDY OBJECTIVE:To determine whether N-acetylcysteine (NAC reduces methemoglobin. METHODS:We carried out an in vitro laboratory experiment in which five healthy adult volunteers donated blood. Each sample was divided equally among three test tubes. Tube 1 served as a negative control. Sodium nitrite .18 mol/L with dex...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Wright RO,Magnani B,Shannon MW,Woolf AD

    更新日期:1996-11-01 00:00:00

  • Effect of a treatment protocol on the efficiency of care of the adult acute asthmatic.

    abstract::A treatment protocol for patients with acute bronchospasm was introduced to an adult emergency department in an attempt to decrease treatment time and potentially decrease need for admission. The charts of all patients seen in a control year (before any protocol was in place) and the first three years of the protocol ...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Schneider SM

    更新日期:1986-06-01 00:00:00

  • Chylous drainage from a stab wound to the neck.

    abstract::A 24-year-old man was assaulted and sustained a stab wound to the left lower neck. When he arrived at the emergency department, he was hemodynamically stable. Although the wound had penetrated the platysma, on initial evaluation the patient did not appear to have sustained significant injury. Closer examination of the...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Pollack CV Jr,Kolb JC,Griswold JA

    更新日期:1990-12-01 00:00:00

  • Quick SOFA Scores Predict Mortality in Adult Emergency Department Patients With and Without Suspected Infection.

    abstract:STUDY OBJECTIVE:The Quick Sequential Organ Failure Assessment (qSOFA) score (composed of respiratory rate ≥22 breaths/min, systolic blood pressure ≤100 mm Hg, and altered mental status) may identify patients with infection who are at risk of complications. We determined the association between qSOFA scores and outcomes...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Singer AJ,Ng J,Thode HC Jr,Spiegel R,Weingart S

    更新日期:2017-04-01 00:00:00

  • Lactic acidosis during closed-chest CPR in dogs.

    abstract::Survival after out-of-hospital cardiac arrest is intimately related to the time from cardiovascular collapse to the initiation of CPR, or downtime. Furthermore, the reperfusion technique that optimizes coronary and cerebral blood flow after cardiac arrest may also be dependent on downtime. Peak blood lactate levels ha...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Carden DL,Martin GB,Nowak RM,Foreback CC,Tomlanovich MC

    更新日期:1987-12-01 00:00:00

  • Effect of dehydration on cardiovascular responses and electrolytes after hypertonic saline/dextran treatment for moderate hemorrhage.

    abstract:STUDY OBJECTIVE:To determine if hypertonic saline/dextran (HSD) is effective in treating hemorrhage in the presence of dehydration. DESIGN:After surgical preparation, swine were euhydrated or dehydrated for 24 or 48 hours. Animals were bled 25 mL/kg over 60 minutes and treated with HSD. SETTING:Laboratory. PARTICIPA...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Wade CE,Tillman FJ,Loveday JA,Blackmon A,Potanko E,Hunt MM,Hannon JP

    更新日期:1992-02-01 00:00:00

  • The role of activated charcoal and gastric emptying in gastrointestinal decontamination: a state-of-the-art review.

    abstract::Gastrointestinal decontamination has been practiced for hundreds of years; however, only in the past few years have data emerged that demonstrate a clinical benefit in some patients. Because most potentially toxic ingestions involve agents that are not toxic in the quantity consumed, the exact circumstances in which d...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章,评审


    authors: Bond GR

    更新日期:2002-03-01 00:00:00

  • Zigadenus poisoning.

    abstract::Significant toxicity can result from ingestion of certain species of the Zigadenus plant, an herb occasionally confused with nontoxic wild onions. A 50-year-old man inadvertently ingested Z paniculatus and presented to the emergency department with profound gastrointestinal toxicity, hypotension, and bradycardia. The ...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Heilpern KL

    更新日期:1995-02-01 00:00:00

  • Survival and neurologic outcome after cardiopulmonary resuscitation with four different chest compression-ventilation ratios.

    abstract:STUDY OBJECTIVE:The optimal ratio of chest compressions to ventilations during cardiopulmonary resuscitation (CPR) is unknown. We determine 24-hour survival and neurologic outcome, comparing 4 different chest compression-ventilation CPR ratios in a porcine model of prolonged cardiac arrest and bystander CPR. METHODS:F...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Sanders AB,Kern KB,Berg RA,Hilwig RW,Heidenrich J,Ewy GA

    更新日期:2002-12-01 00:00:00

  • Fatal pulmonary edema following intravenous "freebase" cocaine use.

    abstract::A 36-year-old man developed extreme shortness of breath after injecting "freebase" cocaine intravenously. Clinical and radiographic evaluation confirmed acute pulmonary edema, and blood gas studies substantiated acute respiratory failure. Despite vigorous therapy, the patient died three hours after admission. When coc...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Allred RJ,Ewer S

    更新日期:1981-08-01 00:00:00

  • HEART Score Risk Stratification of Low-Risk Chest Pain Patients in the Emergency Department: A Systematic Review and Meta-Analysis.

    abstract:STUDY OBJECTIVE:The objectives of this systematic review and meta-analysis are to appraise the evidence in regard to the diagnostic accuracy of a low-risk History, ECG, Age, Risk Factors, and Troponin (HEART) score for prediction of major adverse cardiac events in emergency department (ED) patients. These included 4 su...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章,meta分析


    authors: Laureano-Phillips J,Robinson RD,Aryal S,Blair S,Wilson D,Boyd K,Schrader CD,Zenarosa NR,Wang H

    更新日期:2019-08-01 00:00:00

  • Shortness of breath, syncope, and cardiac arrest caused by systemic mastocytosis.

    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


    authors: Rohr SM,Rich MW,Silver KH

    更新日期:2005-06-01 00:00:00

  • The effect of working serial night shifts on the cognitive functioning of emergency physicians.

    abstract:STUDY OBJECTIVE:We sought to determine whether working 5 serial night shifts in the emergency department results in a decline in physician performance as measured with an intelligence test. METHODS:This study compared the cognitive functioning of emergency physicians who worked the day shift (7 AM to 5 pm) with those ...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Dula DJ,Dula NL,Hamrick C,Wood GC

    更新日期:2001-08-01 00:00:00

  • Outcome of Immediate Versus Early Antibiotics in Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis.

    abstract:STUDY OBJECTIVE:Debate exists about the mortality benefit of administering antibiotics within either 1 or 3 hours of sepsis onset. We performed this meta-analysis to analyze the effect of immediate (0 to 1 hour after onset) versus early (1 to 3 hours after onset) antibiotics on mortality in patients with severe sepsis ...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章,meta分析


    authors: Rothrock SG,Cassidy DD,Barneck M,Schinkel M,Guetschow B,Myburgh C,Nguyen L,Earwood R,Nanayakkara PWB,Nannan Panday RS,Briscoe JG

    更新日期:2020-10-01 00:00:00

  • The critically ill child in the pediatric emergency department.

    abstract::A retrospective study of the charts of all critically ill patients visiting our pediatric emergency department over an 18-month period was conducted to determine age, diagnosis, time of presentation to the pediatric ED, Physiologic Stability Index (PSI) and Therapeutic Intervention Scoring System (TISS) score, and eve...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Kissoon N,Walia MS

    更新日期:1989-01-01 00:00:00

  • Frequent users of emergency departments: the myths, the data, and the policy implications.

    abstract:STUDY OBJECTIVE:Frequent emergency department (ED) users have been the targets of health care reform proposals and hospital crowding interventions, but it is not clear that common assumptions about this group are supported by data. We review the literature pertaining to frequent ED users, their demographics, acuity of ...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章,评审


    authors: LaCalle E,Rabin E

    更新日期:2010-07-01 00:00:00

  • Endocarditis in the emergency department.

    abstract::Clinical presentations and pathogeneses of endocarditis and aspects of its diagnosis and management relevant to emergency department practice are reviewed. Guidelines for admission, laboratory evaluation, and decisions regarding the initiation of therapy in the ED are offered. Also discussed are the role of the emerge...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章,评审


    authors: Delaney KA

    更新日期:1991-04-01 00:00:00

  • Cranial computed tomography scans in children after minimal head injury with loss of consciousness.

    abstract:STUDY OBJECTIVE:To assess the need for cranial computed tomography (CT) in the emergency department evaluation of children with Glasgow Coma Scale (GCS) score of 15 after mild head injury with loss of consciousness. DESIGN:Retrospective case series of children aged 2 to 17 years with documented loss of consciousness a...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Davis RL,Mullen N,Makela M,Taylor JA,Cohen W,Rivara FP

    更新日期:1994-10-01 00:00:00

  • Intravenous adenosine in the emergency department management of paroxysmal supraventricular tachycardia.

    abstract:STUDY PURPOSE:To evaluate the efficacy of adenosine in the treatment of emergency department patients with spontaneous paroxysmal supraventricular tachycardia (PSVT). DESIGN:An eight-month prospective outcome study. POPULATION:Patients 16 or more years old with PSVT by surface ECG criteria. Patients were excluded if ...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Cairns CB,Niemann JT

    更新日期:1991-07-01 00:00:00

  • Nitrous oxide levels in the emergency department.

    abstract::Levels of nitrous oxide were monitored in the emergency department during the use of a Nitronox machine after four and eight minutes of breathing gas. Levels near the user's head were found to be 800 to 1,200 parts per million. Levels at the center of the room peaked at 300 ppm after eight minutes of use, and spot che...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: Dula DJ,Skiendzielewski JJ,Royko M

    更新日期:1981-11-01 00:00:00

  • Lower gastrointestinal hemorrhage from an arterioenteric fistula in a pancreatorenal transplant patient.

    abstract::We report a case of a severe lower gastrointestinal hemorrhage caused by arterioenteric fistula formation in a pancreas transplant patient. A rare but potentially deadly complication of pancreas transplant surgery, arterioenteric fistulas should be considered in every transplant patient presenting with voluminous gast...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章


    authors: McBeth BD,Stern SA

    更新日期:2003-10-01 00:00:00

  • Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest.

    abstract::This multiorganizational literature review was undertaken to provide an evidence base for determining whether or not recommendations for out-of-hospital termination of resuscitation could be made for children who are victims of traumatic cardiopulmonary arrest. Although there is increasing acceptance of out-of-hospita...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章,实务指引,评审


    authors: American College of Surgeons Committee on Trauma.,American College of Emergency Physicians Pediatric Emergency Medicine Committee.,National Association of EMS Physicians.,American Academy of Pediatrics Committee on Pediatric Emergency Medicine.,

    更新日期:2014-04-01 00:00:00

  • Experience with the use of tPA in the treatment of acute myocardial infarction.

    abstract::Early experience with the use of tissue plasminogen activator (tPA) in acute myocardial infarction is reviewed, including comparisons with other thrombolytic agents, a summary of hemorrhagic complications associated with its use, and the rationale for adjunctive therapeutic strategies. The use of tPA has been associat...

    journal_title:Annals of emergency medicine

    pub_type: 临床试验,杂志文章,评审


    authors: Califf RM,Mantell S,Westawski C,Bride W,Honan MB,Bellinger RL,Wall TC

    更新日期:1988-11-01 00:00:00