Comparing TIMI, HEART, and GRACE Risk Scores to Predict Angiographic Severity of Coronary Artery Disease and 30-Day Major Adverse Cardiac Events in Emergency Department Patients with NSTEACS.

BACKGROUND: Acute coronary syndromes (ACS) are hard to diagnose because their clinical presentation is broad. Current guidelines suggest early clinical risk stratification to the optimal site of care. The aim of this study was to investigate the ability of Thrombolysis in Myocardial Infarction (TIMI); History, Electrocardiogram, Age, Risk Factors, Troponin (HEART); and Global Registry of Acute Coronary Events (GRACE) risk scores to predict the development of major adverse cardiac events (MACE) and the angiographic severity of coronary artery disease (CAD) in patients diagnosed with non-ST-segment elevation acute coronary syndrome (NSTEACS) in the emergency department (ED). In addition, independent variables associated with the development of MACE were also examined. METHODS: This study is a prospective, observational, single-center study. All patients over 18 years of age who were planned to be hospitalized for pre-diagnosed NSTEACS (NSTEMI + UAP) were included in the study consecutively. Patients' demographic information and all variables necessary for calculating risk scores (TIMI, HEART, and GRACE) were recorded. Two experienced cardiologists evaluated all coronary angiograms and calculated the Gensini score. RESULTS: The median age was 60 (IQR: 18) years, and 220 (61.6%) were male of the 357 patients included in the study. In this study, 91 MACE (52 percutaneous coronary interventions [PCI], 28 coronary artery bypass graft [CABG], three cerebrovascular disease [CVD], and eight deaths) occurred. The 30-day MACE rate was 25.5%. The low-risk group constituted 40.0%, 1.4%, and 68.0% of the population, respectively, in TIMI, HEART, and GRACE scores. Multiple logistic regression models for predicting MACE, age (P = .005), mean arterial pressure (MAP; P = .015), and High-Sensitive Troponin I (P = .004) were statistically significant. CONCLUSION: The ability of the GRACE, HEART, and TIMI risk scores to predict severe CAD in patients with NSTEACS is similar. In patients with NSTEACS, the HEART and GRACE risk scores can better predict the development of MACE than the TIMI risk score. When low-risk groups are evaluated according to the three risk scores, the HEART score is more reliable to exclude the diagnosis of NSTEACS.

Occupational accidents of emergency medicine residents in Turkey.

Objectives. Healthcare workers face many biologic, chemical, physical and psychosocial hazards and risks in their work environment. Our research aimed to examine the types and frequency of occupational accidents, their notification status and predisposing factors to which emergency medicine residents (EMRs) were exposed in the last 12 months in Turkey. Methods. This research is a national, multicenter, online descriptive survey study. Participants' descriptive features, characteristics of occupational accidents they were exposed to in the last 12 months and their use status of personal protective equipment (PPE) were examined. Results. We found that 215 EMRs were exposed to 1919 occupational accidents in the last 12 months, and only 287 of these accidents were reported. All participants had at least one occupational accident in the previous 12 months. PPE was not used in 37.9 and 44% of biologic and chemical transmission accidents, respectively. The PPE use frequency of the EMRs in necessary situations for examination gloves, surgical masks, respirators, goggles, gowns and face shields was 60, 19, 19, 8, 15 and 4%, respectively. Conclusion. The actual number of occupational accidents was determined to be considerably higher than those reported. PPE use habits of EMRs were less than they should be.