BACKGROUND AND IMPORTANCE: In 2018, the European Society of Cardiology (ESC) produced syncope guidelines that for the first-time incorporated Emergency Department (ED) management. However, very little is known about the characteristics and management of this patient group across Europe. OBJECTIVES: To examine the prevalence, clinical presentation, assessment, investigation (ECG and laboratory testing), management and ESC and Canadian Syncope Risk Score (CSRS) categories of adult European ED patients presenting with transient loss of consciousness (TLOC, undifferentiated or suspected syncope). DESIGN: Prospective, multicentre, observational cohort study. SETTINGS AND PARTICIPANTS: Adults (≥18 years) presenting to European EDs with TLOC, either undifferentiated or thought to be of syncopal origin. MAIN RESULTS: Between 00:01 Monday, September 12th to 23:59 Sunday 25 September 2022, 952 patients presenting to 41 EDs in 14 European countries were enrolled from 98 301 ED presentations (n = 40 sites). Mean age (SD) was 60.7 (21.7) years and 487 participants were male (51.2%). In total, 379 (39.8%) were admitted to hospital and 573 (60.2%) were discharged. 271 (28.5%) were admitted to an observation unit first with 143 (52.8%) of these being admitted from this. 717 (75.3%) participants were high-risk according to ESC guidelines (and not suitable for discharge from ED) and 235 (24.7%) were low risk. Admission rate increased with increasing ESC high-risk factors; 1 ESC high-risk factor; n = 259 (27.2%, admission rate=34.7%), 2; 189 (19.9%; 38.6%), 3; 106 (11.1%, 54.7%, 4; 62 (6.5%, 60.4%), 5; 48 (5.0%, 67.9%, 6+; 53 (5.6%, 67.9%). Furthermore, 660 (69.3%), 250 (26.3%), 34 (3.5%) and 8 (0.8%) participants had a low, medium, high, and very high CSRS respectively with respective admission rates of 31.4%, 56.0%, 76.5% and 75.0%. Admission rates (19.3-88.9%), use of an observation/decision unit (0-100%), and percentage high-risk (64.8-88.9%) varies widely between countries. CONCLUSION: This European prospective cohort study reported a 1% prevalence of syncope in the ED. 4 in 10 patients are admitted to hospital although there is wide variation between country in syncope management. Three-quarters of patients have ESC high-risk characteristics with admission percentage rising with increasing ESC high-risk factors.
- MeSH
- dospělí MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- synkopa * diagnóza epidemiologie terapie MeSH
- urgentní služby nemocnice * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- Geografické názvy
- Kanada MeSH
Urgentní příjmy se v Česku budují až v posledních letech. Senioři jsou typickými pacienty těchto oddělení. Přístup v urgentní medicíně je založen na vyhodnocení příznaků a na stanovení priority ošetření pacienta. Přístup k pacientům vyššího věku má mnohá specifika v diagnostice i v léčbě. Triáž geriatrických pacientů se zpřesní zhodnocením kognice, škály geriatrické křehkosti a screeningových nástrojů pro posouzení přítomnosti deliria. Komplexní geriatrické hodnocení je pro časovou náročnost pro urgentní příjem nevhodné, ale je nutné zachovat jeho základní komponenty. Léčebný přístup musí být komplexní a musí obsahovat aspekty biologické, psychologické i sociální a analýzu rizik prostředí. Management úrazů seniorů vyžaduje vyhodnocení odlišných kritických hodnot vitálních funkcí oproti kritériím běžné triáže, vlivu medikace na adaptační mechanismy a rizika nízkoenergetických mechanismů traumat. Léčba úrazů musí být včasná a komplexní a je nutné zajistit kontinuitu při přechodu z intenzivní do standardní péče a dále do péče rehabilitační. U pacientů v terminálním stadiu nevyléčitelného onemocnění je na místě paliativní přístup.
Emergency departments in the Czech Republic have been established in recent years. Seniors are typical patients of these departments. Emergency medicine´s approach is based on symptoms’ evaluation and on deciding about the priority of the care needed. The approach to older patients is specific both in diagnostics and in therapy. The triage of geriatric patients is more accurate when we also evaluate patient´s cognition, when we use geriatric frailty scales and screening tools for detection of delirium. Comprehensive geriatric evaluation is a time demanding process and thus inadequate for emergency department however we must maintain its basic components. The therapeutical approach must be complex, and it must include biological, psychological, and social aspects and environmental risk analysis. Trauma management in seniors requires evaluation of different vital function´s values compared to common triage criteria, the influence of medication on adaptive mechanisms and the risk of low energy trauma mechanisms. Therapy of trauma must be timely and complex and the continuity of care between intensive and standard level and then rehabilitation must be ensured. Palliative approach is appropriate for terminally ill patients.
Urgentní příjmy jsou charakterem poskytované péče rizikovým prostředím. Chyby spojené s poskytováním zdravotní péče jsou z velké části preventabilní. Ke snížení bezpečnosti na urgentním příjmu přispívá nárazové přetížení, přerušování péče a multitasking, rušné prostředí, komplexita pacientů, časový tlak a nutnost stálého rozhodování a s tím spojená i zodpovědnost. Bezpečnost poskytované péče je jedním z klíčových prvků kvality. Je potřeba analyzovat data o nežádoucích událostech a bezpečnostních incidentech a na základě analýzy chyb provést preventivní opatření. Pozornost je potřeba věnovat i pracovním podmínkám personálu a eliminovat tak chyby ovlivněné únavou, vyčerpáním, ztrátou koncentrace nebo vyhořením.
Emergency department is by nature of the provided care a risky environment. Medical errors associated with providing care are in most cases preventable. Overcrowding, frequent disruption of care, multitasking, busy environment, complexity of cases, time pressure and continuous decision-making together with high responsibility are some of the reasons which decrease the safety at emergency departments. Safety of the provided care is one of key elements of quality. It is necessary to analyze the data on adverse events and safety incidents and take preventive measures based on this analysis. It is also importatnt to pay attention to working conditions of the personel and eliminate errors coming from fatigue, exhaustion, loss of concentration or burnout.
BACKGROUND: Point-of-care (POC) high-sensitivity cardiac troponin assays may further accelerate the diagnosis of myocardial infarction (MI). OBJECTIVES: This study sought to assess the clinical and analytical performance of the novel high-sensitivity cardiac troponin I (hs-cTnI)-SPINCHIP POC test. METHODS: Adult patients presenting with acute chest discomfort to the emergency department were enrolled in an international, diagnostic, multicenter study. The final diagnosis was centrally adjudicated by 2 independent cardiologists using all clinical information. We compared the discriminatory performance of hs-cTnI-SPINCHIP with current established central laboratory assays and derived an assay-specific hs-cTnI-SPINCHIP 0/1-hour algorithm. Secondary analyses included sample type comparisons (whole blood, fresh/frozen plasma, and capillary finger prick) and precision analysis. RESULTS: MI was the adjudicated final diagnosis in 214 (19%) of 1,102 patients. Area under the receiver-operating characteristic curve was 0.94 (95% CI: 0.92-0.95) for hs-cTnI-SPINCHIP vs 0.94 (95% CI: 0.92-0.95) for hs-cTnI-Architect (P = 0.907) and 0.93 (95% CI: 0.91-0.95) for high-sensitivity cardiac troponin T Elecsys (P = 0.305). A cutoff <7 ng/L at presentation (if chest pain onset was >3 hours) or <7 ng/L together with a 0/1-hour delta of <4 ng/L ruled out 51% with a sensitivity and negative predictive value of 100% (95% CI: 97.7%-100%) and 100% (95% CI: 99.0%-100%), respectively. A hs-cTnI-SPINCHIP concentration ≥36 ng/L or a 0/1-hour delta ≥11 ng/L ruled in 27% with a specificity and positive predictive value of 90.9% (95% CI: 88.3%-92.9%) and 72.9% (95% CI: 66.4%-78.6%), respectively. Bootstrap internal validation confirmed excellent diagnostic performance. High agreement was observed between different sample types. CONCLUSIONS: The SPINCHIP hs-cTnI POC test has very high diagnostic accuracy. Its assay-specific 0/1-hour algorithm achieved very high sensitivity/negative predictive value and specificity/positive predictive value for rule-out/in MI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study [APACE]; NCT00470587).
- MeSH
- biologické markery krev MeSH
- infarkt myokardu * krev diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- troponin I * krev MeSH
- vyšetření u lůžka MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Klíčová slova
- dokument ESPEN,
- MeSH
- dieta s nízkým obsahem soli * MeSH
- lidé MeSH
- randomizované kontrolované studie jako téma MeSH
- stravovací služby nemocnice * MeSH
- Check Tag
- lidé MeSH
