A Prospective Study on Diagnostic Chest Pain Protocol

PURPOSE: For appropriate triage of chest pain patients in the emergency room (ER), We verified whether or not a new chest pain protocol, which is a combination of Goldman algorithm Cardiac STATus(r) adequately reflects the risk of a major cardiac event in patients with acute chest pain. METHODS: All patients arriving at the ER were divided into 4 risk group based on the Goldman MI probability and on the result of cardiac STATus(r). one month later, we collected information on whether the patients had undergone major cardiac event or death. We analyzed relative risk (RR) of cardiac event by using a logistic regression and we compare the event-free survival rates and survival lengths. RR=2 mean that the risk of cardiac events is high by two folds than control group. RESULTS: There were 31 major cardiac events. the relative risk of major events of each group compared to group 4 were 40.1 for group 1, 51.9 for group 2 and 27.4 for group 3. Group 4 patients experienced one cardiac event and no deaths. The survival time without a cardiac event of group 4 patients approach 30 days within experimental error. The survival rate without a cardiac event is 0.98+/-0.02. Therefore, the patients in group 4 had life expectancies similar to those of normal persons. CONCLUSION: This chest pain protocol adequately reflects the chances of cardiac event, so patients who show a negative result in cardiac STATus(r) and a low Goldman MI probability can be safely discharged from ER and followed up in outpatient clinic.

Clinical Analysis of Delayed Intracranial Hemorrhage in Head Injury

Experinece in the management of 74 patients with delayed traumatic intracranial hemorrhage(DTICH) of 474 head injury from January 1996 to December 1996 is poresented with emphasis on the incidence, occurring time, risk factors and outcome. The incidence of DTICH was 15.6% of all hospitalized head-injury patients. After an injury, every patient had an immediate computerized tomography(CT) scan to diagnose intracranial pathology and then CT follow-up was carried out according to intial CT finding and reurological deficit. The lesion was almost occurred in patients with initial abnormal CT finding(85.1%). 82.4% of DTICH were noted within 72 hours after injury. The delayed epidural hematoma and intracerebral hemorrhage were almost noted in first 72 hours(>90%), but the delayed subdural hemorrhage was found after a time interval varying from 6 hours to 10 days. So we strongly recommend CT follow-up in 4-8hour, 24-72hour, and then 7th day after head injury, especially in patients with initial abnormal CT findings. The risk factor of the delayed lesion was not hypotension, hypoxia, and consciousness level, but age of patients and the initial CT finding. The development of DTICH was not heralded by neurological deterioration. The prognosis of DTICH was not worse than non-DTICH. The patient with delayed subdural hemorrhage was better than the patient with non-delayed lesion(including hemorrhage and normal CT finding).