High-Sensitivity Troponin I Assay for DifferentialDiagnosis of New-Onset Myocardial Infarctionin Patients with Acute Decompensated Heart Failure

Purpose@#Acute decompensated heart failure (ADHF) caused by ischemic heart disease is associated with higher mortality and requires immediate diagnosis. Recently, novel methods to diagnose non-ST elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin have been applied. We compared the clinical utility of high-sensitivity troponin I (hS-TnI), delta troponin I, and other traditional methods to diagnose NSTEMI in patients with ADHF. @*Materials and Methods@#This retrospective cross-sectional study was conducted to analyze patients with ADHF who underwent hS-TnI evaluation of 0–2-h protocol in our emergency department. Patients were grouped according to a diagnosis of NSTEMI. @*Results@#A total of 524 ADHF [ADHF with NSTEMI, n=109 (20.8%)] patients were enrolled in this analysis. The mean values of hS-TnI (ng/mL) in the ADHF with and without NSTEMI groups were 2.44±5.60 and 0.25±0.91, respectively. Multivariable analysis revealed that regional wall-motion abnormality, T-wave inversion/hyperacute T wave, and initial and delta hS-TnI were predictive factors for NSTEMI. Laboratory values related to cardiac biomarkers, including hS-TnI [odds ratio (OR) (95% confidence interval, CI): 2.18], and the delta hS-TnI [OR (95% CI): 1.55] were significant predictors of NSTEMI. Moreover, receiver operating characteristic analysis showed that the areas under receiver operating characteristic curves for electrocardiographic abnormalities, initial hS-TnI, and delta hS-TnI were 0.794, 0.802, and 0.773, respectively. @*Conclusion@#For diagnosis of suspected NSTEMI in patients with ADHF, initial hS-TnI assay has similar predictive value as ischemic changes on electrocardiogram and superior predictive value than delta hS-TnI calculated by the 0–2-h protocol.

Validation of a novel diagnostic nomogram for pulmonary thromboembolism in the emergency department

Objective@#Diagnosis of pulmonary thromboembolism (PTE) is essential for preventing serious complications in the emergency department (ED) or intensive care unit. Contrast computed tomography (CT) of the chest is used for confirming pulmonary embolism, but there is a low specificity and radiation- or contrast-related side effects. We developed a novel nomogram to facilitate decision-making for performing contrast CT of the chest in the ED. @*Methods@#A retrospective observational study was conducted to develop a prediction model of PTE. The prediction model was derived from demographic characteristics, clinical history data and results of laboratory tests, ultrasonography and echocardiography. A nomogram was constructed from the variables of the prediction model and validated. @*Results@#A total of 326 patients were analyzed (a training cohort, 260; a validation cohort, 66). Wells’ score, D-dimer level>1,100 ng/dL, positive McConnell’s sign and D-shaped left ventricle were associated with the occurrence of PTE. The overall predictive accuracy of the prediction model was 0.802 (0.748-0.849) (area under the curve with 95% confidence interval). The calibration plots for the probability of PTE showed good agreement between the nomogram prediction and actual probability among cohorts. @*Conclusion@#A novel nomogram using risk stratification, laboratory test and sonographic examination findings is a good screening tool for predicting PTE, and it can be helpful to decide whether an ED physician should perform a contrastenhanced chest CT in the ED.

Reduced Mortality in Severely Injured Patients Using Hospital-based Helicopter Emergency Medical Services in Interhospital Transport

Recent evidence has demonstrated the survival benefits of helicopter transport for trauma patients. The purpose of this study was to evaluate the effectiveness of hospital-based helicopter emergency medical services (H-HEMS) in comparison with ground ambulance transport in improving mortality outcomes in patients with major trauma. Study participants were divided into 2 groups according to type of transport to the trauma center; that is, either via ground emergency medical services (GEMS) or via H-HEMS. The study was conducted from October 2013 to July 2015. Mortality outcomes in the H-HEMS group were compared with those in the GEMS group by using the Trauma and Injury Severity Score (TRISS) analysis. The number of participants finally included in the study was 312. Among these patients, 63 were adult major trauma patients transported via H-HEMS, and 47.6% were involved in traffic accidents. For interhospital transport, the Z and W statistics revealed significantly higher scores in the H-HEMS group than in the GEMS group (Z statistic, 2.02 vs. 1.16; P = 0.043 vs. 0.246; W statistic, 8.87 vs. 2.85), and 6.02 more patients could be saved per 100 patients when H-HEMS was used for transportation. TRISS analysis revealed that the use of H-HEMS for transporting adult major trauma patients was associated with significantly improved survival compared to the use of GEMS.

The Influence of Low Serum Sodium Levels on the Risk of the Repeat of Febrile Convulsions

PURPOSE: Fever plays an important role in causing disturbances in the fluid and electrolyte balance, especially in an immature brain. Recently, it was reported that hyponatremia enhanced the susceptibility of febrile convulsions in children and increased the risk of repeat convulsions during the same febrile illness. We studied the relationship between hyponatremia and febrile convulsions. METHODS: Blood samples for electrolyte measurements were taken from 52 children who visited Chosun University Hospital between June 1997 and July 1998(patient group I: simple febrile convulsion, patient group II: repeated febrile convulsions). We checked serum electrolytes in groups of age-matched controls(control group I: no fever, no convulsion, control group II: fever only, control group III: non-febrile convulsion). The results were analyzed by Student's t-test and ANOVA test. RESULTS: The mean serum sodium level of both patient groups(136.8+/-2.3mmol/L) was significantly lower when compared to all control groups(control groupI: 140.7+/-2.5mmol/L, control group II: 139.7+/-3.1mmol/L, control group III: 139.7+/-4.6mmol/L)(P0.05). The mean serum sodium level in the group with repeat convulsions(136.8+/-2.4mmol/L) was not significantly lower than the mean in the group with simple febrile convulsions(136.7+/-2.2mmol/L). There was no statistical relationship between the level of serum sodium and the probability of repeat convulsions(r=0.19, P>0.05). CONCLUSION: Our results show that low serum sodium concentration may increase the risk of febrile convulsions. However, there is no statistical relationship between the level of serum sodium and the probability of repeat convulsions. These findings warrant further studies on the relationship between the control of electrolyte levels and seizures.