Clinical risk assessment in decision making for hospital discharge of patients with pulmonary embolism / Klinikai kockázatbecslésen alapuló döntéshozatal a tüdoemboliás betegek kórházi elbocsátása során

Introduction: There are a vast number of studies that analyze the safest possible way of early at-home treatment of patients with pulmonary embolism after diagnosis. Objective: Our study aimed to find out how many patients could be discharged safely and without complications, if using the three validated score systems of the 2019 European Society of Cardiology guideline regarding pulmonary embolism. Method: Throughout our retrospective, quantitative study, we gathered data from the 2015-2018 period before the establishment of the new, 2019 guideline. We assessed patients who had a diagnosis of pulmonary embolism at the emergency room in the given period. With the help of the prognostic score systems, we retrospectively made a risk stratification using the main symptoms and vital parameters. We analyzed the categorical variables with chi-square test. For assessing two continuous variables, we used Pearson's correlation. We defined our level of significance at p<0,05. Results: 374 (199 female and 175 male) patients were enrolled in our study. Our retrospective calculation had the following results: based on the PESI score 151 patients, on the basis of the sPESI 101 patients and according to the Hestia criteria 50 patients could have been discharged, treated at home without complications and increasing the mortality. The negative predictive value (PESI: 98%, sPESI: 100%, Hestia: 100% with CI: 95%) and sensitivity (PESI: 91%, sPESI: 100%, Hestia: 100%) of the three prognostic scores showed applicable efficiency. Conclusion: We concluded that all three prognostic criteria can be used safely taking the local clinical experience and preference into consideration, aiming at early discharge. Adapting them nationally could decrease hospital load.

The importance of clinical risk assessment in reducing the pathway of acute coronary syndrome / A klinikai kockázatbecslés jelentosége az akut coronaria szindróma betegút csökkentésében

Introduction: Early diagnosis of acute coronary syndrome is emergency providers' task. In the last decade, vast amounts of clinical risk stratification scores were developed to decrease the hospital load of patients by selecting them properly. Objective: Together with the diagnostic and therapeutic challenges, decreasing treatment duration is essential for the improvement of acute coronary syndrome prognosis. Our aim was to assess the HEART score's time-and therapy -related effects on acute coronary syndrome detection as a decision support system. Method: We conducted a retrospective, quantitative study at a county state emergency department amongst patients with the myocardial infarction ICD codes. We assessed their admission time, the way they were delivered to the hos-pital, their presenting symptoms, vital parameters, chronic medical conditions, laboratory and imaging results and the time of their admission to the percutan intervention center. We calculated the HEART score retrospectively from the collected data. Results: Our sample size consisted of 360 people. Coronary artery disease (80%) and hypertension (73.3%) were the most common risk factors, while chest pain (80%) and shortness of breath (48.6%) were the most common com-plaints. Coronary artery disease, hypertension and diabetes are not related to percutan coronary intervention admis-sion times (p = 0.110; p = 0.173; p = 0.507). We found a correlation between the presence of chest pain and mortal-ity (p = 0.009). The calculated HEART score had a correlation with the fact of coronary intervention admission (p = 0.005). Conclusion: We conclude that the retrospectively calculated HEART score correlates with percutan coronary inter-vention admission. Choosing the proper risk stratification can increase the lifespan of the patients and hospital cost-efficiency.

"Decide and run!" The role of prehospital care providers in reducing time loss for patients with stroke diagnosis / "Dönts és siess!" A prehospitális ellátók szerepe az idoveszteség csökkentésében stroke-iránydiagnózisú betegek esetén.

Összefoglaló. Bevezetés: A stroke-betegek ellátásában arra kell törekedni, hogy a tünetek jelentkezését követoen minél elobb a szakmai centrumba kerüljön a beteg. Célkituzés: Kutatásunkban a terápiás idoablak tarthatósága céljából vizsgáltuk, hogy mely tényezok bírnak hatással a prehospitális ellátás idotartamaira. Módszer: Keresztmetszeti, kvantitatív kutatásunkhoz az adatgyujtést két magyarországi város mentoállomásán, orvosi kompetenciával rendelkezo (eset-, rohamkocsi) és orvosi kompetenciával nem rendelkezo (mentogépkocsi) mentoegység szintjén végeztük 2017-es adatok feldolgozásával olyan betegek körében, akiknek a mentoegység általi iránydiagnózisa stroke volt (n = 220). Vizsgáltuk, hogy a mentoegységek által elvégzett vizsgálatok, a tapasztalt tünetek, a terápiás idoablakon belüliség miként befolyásolta a prehospitális idoket. Az adatfeldolgozást SPSS 26.0 statisztikai programmal végeztük. Az elemzéshez leíró statisztikát, χ2-próbát, F-próbát és T-próbát alkalmaztunk. Eredmények: Megállapítottuk, hogy az alkalmazott score-rendszer vizsgálati elemei közül, ha aphasia volt észlelheto a betegnél, úgy szignifikánsan meghosszabbodott a helyszínen töltött ido (p = 0,003). A gyors ABCDE-betegvizsgálat D-lépésében kötelezo a betegnél a vércukorszintmérés, ugyanakkor ez mintánk 25,45%-ában elmaradt. A helyszíni muszeres vércukorszintmérés hatással van a prehospitális késés alakulására az orvosi kompetencia nélküli egységek vonatkozásában (p<0,001). Következtetés: A helyszínen töltött ido az emelt szintu mentoegységek esetében hosszabb, mint az alacsonyabb szintu egységeknél. Következtetésként levonhatjuk, hogy a motoros vagy szenzoros aphasia nem befolyásolja a terápiát, pusztán a stroke-diagnózis valószínuségét növelo egyik tünet, így a helyszíni ido emiatti megnyúlása mindenképpen kerülendo, amire javasolt a továbbképzések alkalmával is felhívni az ellátók figyelmét. Az orvosi kompetencia nélküli egységek esetében beavatkozást igényel a muszeres vércukormérés idorabló hatásának csökkentése, hiszen látható, hogy az orvosi kompetenciával rendelkezo egységeknél ez a vizsgálat nem jelenik meg mint késést okozó tényezo. Orv Hetil. 2022; 163(7): 279-287. INTRODUCTION: When treating stroke patients, the aim should be to get the patient to a specialist stroke centre as soon as possible. OBJECTIVE: In our study, in order to be able to stay within the therapeutic window, we investigated which variables affect the time period of prehospital treatment. METHOD: For our cross-sectional quantitative study, we gathered data from two ambulance stations in Hungary, comparing the competence of physician and non-physician units. We processed information from 2017 regarding patients whose initial diagnosis was stroke (n = 220). We examined how investigations by the ambulance unit, symptoms experienced and therapeutic time window have affected prehospital times. As for the statistic software, we used SPSS 26.0. The analysis was conducted by performing χ2 test, F-test and T-test. RESULTS: We identified that if the aphasia component of the used score system was positive, the on-scene time increased significantly (p = 0.003). In the D section of the rapid ABCDE assessment, it is mandatory to measure the blood glucose level of the patient, however, in our sample it was omitted in 25.45% of the cases. We identified that on-site blood glucose measurement has an effect on prehospital delay for non-physician units (p<0.001). CONCLUSION: We found that the on-scene time is longer for physician units than for non-physician units. We concluded that motor or sensory aphasia does not affect the therapy, it is just one of the symptoms that can increase the likelihood of stroke diagnosis, therefore prolonging time for assessing aphasia in the field should be avoided. Moreover, it is recommended to make care providers aware of this during training sessions. Improvements are required in non-physician units to reduce the time consumed by blood glucose measurement, as it has been shown that within physician units this test does not appear to be a delay-causing factor. Orv Hetil. 2022; 163(7): 279-287.