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Deborah B Diercks

Publications and source records attributed to Deborah B Diercks.

30 records · Page 2Linked to original sources
PubMed2004

Derivation and validation of a risk stratification model to identify coronary artery disease in women who present to the emergency department with potential acute coronary syndromes.

OBJECTIVES: To derive and validate a model to identify women who would benefit from further evaluation of chest pain after an initial negative emergency department (ED) evaluation for acute coronary syndrome (ACS). METHODS: The derivation and validation cohorts were comprised of women who presented to the ED with chest pain at two university hospitals. Patients were excluded if the initial electrocardiogram (ECG) or cardiac markers were consistent with ACS. Patients were followed for 30 days after the index visit to identify evidence of coronary artery disease (CAD), which was defined as a positive diagnostic study, myocardial infarction, or death. The authors performed a logistic regression analysis to identify significant predictors of CAD. A scoring system was developed based on the B-coefficient of these significant predictors. Levels of risk were assigned by summing and categorizing the cumulative risk score into low-, moderate-, and high-risk groups. RESULTS: The derivation and validation sets were comprised of 733 and 2,440 women, respectively. From the derivation set predictors of CAD (score) were history of CAD (1), age > or = 60 years (1), and high clinical suspicion (3). Low risk was defined as a score = 0, moderate risk score = 1-2, high risk score > or = 3. In the validation set, the numbers of patients with evidence of CAD were four of 1,348 (0.30%), 18 of 498 (3.6%), and 71 of 594 (11.9%) in the low-, moderate-, and high-risk groups, respectively. CONCLUSIONS: The risk of underlying CAD in women who present to the ED with potential ACS may be determined using a simple risk stratification score.

California↗
PubMed2003

Frequency of acute coronary syndrome in patients presenting to the emergency department with chest pain after methamphetamine use.

We reviewed the frequency of acute coronary syndrome (ACS) in patients presenting to our emergency department (ED) with chest pain after methamphetamine (MAP) use during a 2-year interval. Thirty-three patients (25 males, 8 females; average age 40.4 +/- 8.0 years) with a total of 36 visits met study inclusion criteria: 1) non-traumatic chest pain, 2) positive MAP urine toxicology screen, 3) admission to "rule-out" myocardial infarction, 4) chest radiograph demonstrating no infiltrates. An ACS was diagnosed in 9 patients (25%). Three patients (8%) (2 ACS and 1 non-ACS) suffered cardiac complications (ventricular fibrillation, ventricular tachycardia, supraventricular tachycardia, respectively). Age, gender, cardiac risk factors, prior coronary artery disease, initial systolic blood pressure and heart rate did not differ significantly in the ACS and non-ACS groups. The initial and subsequent electrocardiograms (EKG) were normal in 1/9 (11%) patients with ACS and 16/27 (59%) without ACS (p < 0.05). Our findings suggest that: 1) ACS is common in patients hospitalized for chest pain after MAP use, and 2) the frequency of other potentially life-threatening cardiac complications is not negligible. A normal EKG lowers the likelihood of ACS, but an abnormal EKG is not helpful in distinguishing patients with or without ACS.

Academic Medical Centers↗
PubMed2003

Bioimpedance-derived differences in cardiac physiology during exercise stress testing in low-risk chest pain patients.

BACKGROUND: Little has been written about the utility of thoracic electrical bioimpedance (TEB)-derived cardiac physiologic variables in evaluating patients with low-risk chest pain syndromes. Noninvasive bioimpedance can monitor cardiac physiology while a patient is performing an exercise stress test. In addition, the demographics of patients with chest pain, the incidence of coronary artery disease (CAD), and the methods used for evaluation have well-documented sex differences. OBJECTIVE: The objectives are to show that there are different cardiac physiologic responses to exercise stress test in Chest Pain Evaluation Unit patients with and without true CAD that could be used to stratify patients and that there is a sex difference in TEB results. METHODS: Patients 18 to 65 years of age with low-risk chest pain were eligible. Patients were attached to the TEB throughout the exercise stress test procedure. Heart rate (HR) was monitored. Primary dependent variables were TEB-measured cardiac output (CO, L/min) and stroke volume (SV, ml) at peak exercise. Secondary variables were TEB-measured ejection fraction (%), end-diastolic volume (EDV, ml), ventricular ejection time (ms), and thoracic fluid index (omega) at peak exercise. Outcome variables were either proved CAD or patient sex. CAD was proved by angiography, stress scintigraphy, or stress echocardiogram. Results were compared using a Student's t test assuming equal variances, with significance considered at a P < 0.05, and 95% confidence intervals were calculated for significant results. RESULTS: Nine patients had proved CAD, 82 patients did not. Forty-three women and 48 men were included in the study. At peak exercise, patients with CAD had a significantly smaller increase in EDV than patients without CAD (32.8 +/- 59.5 ml versus 89.3 +/- 101.8 ml) without a significant change in CO, SV, or HR. At peak exercise, women had a significantly smaller increase in CO and SV without a significant change in HR. In addition, women had a significantly smaller increase in EDV. CONCLUSION: When compared with patients without CAD, patients with CAD have a significantly smaller increase in EDV and a trend toward the same effect in CO and SV. Women have significantly smaller increases CO, SV, and EDV compared with men. Because there were no differences in HR, using HR as the sole end point would miss these differences. TEB is a practical means of measuring these variables.

Adolescent↗
PubMed2002

Immediate exercise testing to evaluate low-risk patients presenting to the emergency department with chest pain.

OBJECTIVES: Our purpose was to determine the safety and accuracy of immediate exercise testing in low-risk patients presenting to the emergency department (ED) with chest pain suggestive of a cardiac etiology. BACKGROUND: Safe, efficient management of low-risk patients presenting to the ED with chest pain is a continuing challenge. We have employed immediate exercise testing to evaluate a large, heterogeneous group of low-risk patients presenting with chest pain. METHODS: Patients presenting to the ED with chest pain compatible with a cardiac origin and clinical evidence of low risk on initial assessment underwent immediate exercise treadmill testing in our chest pain evaluation unit. Indicators of low clinical risk included no evidence of hemodynamic instability, arrhythmias or electrocardiographic signs of ischemia. Serial measurements of cardiac injury markers were not obtained. RESULTS: Exercise testing was performed to a sign- or symptom-limited end point in 1,000 patients (520 men, 480 women; age range 31 to 82 years) and was positive for ischemia in 13%, negative in 64% and nondiagnostic in 23% of patients. There were no adverse effects of exercise testing, and all patients with a negative exercise test were discharged directly from the ED. At 30-day follow-up there was no mortality in any of the three groups. Cardiac events in the three groups included: negative group, 1 non-Q-wave myocardial infarction (MI); positive group, 4 non-Q-wave MIs and 12 myocardial revascularizations; nondiagnostic group, 7 myocardial revascularizations. BACKGROUND: Immediate exercise testing of patients presenting to the ED with chest pain and evidence of low clinical risk is safe and accurate for determining those who require admission and those who can be discharged to further outpatient evaluation.

Adult↗
PubMed2002

Acute ischemic syndromes. Chest pain center concept.

CPCs have been developed to meet the clinical challenge posed by the diverse group of patients presenting to the ED with findings suggestive of a coronary event. Using a protocol-driven approach, high- and low-risk patients can be identified on presentation, facilitating urgent therapy in the former and triage of the latter to more deliberate management. Most CPCs focus on low-risk patients who are being increasingly managed by accelerated diagnostic protocols. These methods comprise systematic strategies that include innovative diagnostic approaches during a 6 to 12 hour period of observation with serial ECGs, continuous monitoring and cardiac biomarker measurements. A negative evaluation is usually followed by predischarge stress testing, and positive findings mandate admission. An essential aspect of the CPC strategy is continuity of care for patients with negative cardiac evaluations. Current data indicate that management of low-risk patients with chest pain in a CPC is safe accurate, and appears to be cost-effective.

Algorithms↗
PubMed2002

Cholesterol screening in an ED-based chest pain unit.

To evaluate the prevalence of dyslipidemia in patients who are evaluated in a chest pain evaluation unit (CPEU) a prospective study of all patients admitted to our CPEU from January 1 to December 31, 1999 was conducted. Serum total cholesterol (TC) and high density lipoprotein (HDL) levels were obtained unless prior levels were known or at the discretion of the attending physician. Both TC and HDL were tested in 606 (59%) patients. Abnormal lipid levels were reported in 306 (50%) patients. Of these, 86 had both abnormal TC and HDL. Isolated low HDL levels were found in 60 of the patients and TC alone was abnormal in 160. Of the 246 patients with abnormal TC, 169 (69%) had borderline high levels (200-239 mg/dL) and 77 (31%) had high levels (>or=240 mg/dL). Our study shows a high prevalence of abnormal lipid levels in patients, as identified by a screening protocol in our CPEU.

Adult↗
PubMed2000

Prochlorperazine versus promethazine for uncomplicated nausea and vomiting in the emergency department: a randomized, double-blind clinical trial.

STUDY OBJECTIVE: Nausea and vomiting related to gastritis or gastroenteritis are common complaints in the emergency department. The most effective antiemetic agent is yet undetermined. This study was conducted to compare the efficacy of prochlorperazine versus promethazine for uncomplicated nausea and vomiting in the ED. METHODS: The study was a randomized, double-blind comparison of prochlorperazine (Compazine) and promethazine (Phenergan) for acute ED treatment of gastritis or gastroenteritis. We studied patients 18 years or older with presumed uncomplicated gastritis or gastroenteritis who presented to 2 academic EDs. Patients were randomly assigned to receive either prochlorperazine, 10 mg intravenously, or promethazine, 25 mg intravenously. Visual analog scale readings of patient comfort were obtained at baseline and at 30- and 60-minute intervals. The primary endpoint was degree of relief at 30 and 60 minutes. Secondary endpoints were time to complete relief, need for further antiemetic medication (treatment failures), and side effects. Statistical analysis was performed using the Mann-Whitney U test for nonparametric analysis and repeated-measures analysis of variance (ANOVA). RESULTS: Eighty-four patients were enrolled in the study; 42 received prochlorperazine and 42 received promethazine. There were no differences in demographics in the 2 groups. At baseline (time 0), there was no difference in symptoms (P =.23). At 30 and 60 minutes after receiving medication, prochlorperazine worked significantly better than promethazine (P =.004 and P <.001 using nonparametric analysis). Using repeated-measures ANOVA, there was a significant difference in symptoms over time for both groups (P <.001) and a significant difference in prochlorperazine versus promethazine (P =.002). Time to complete relief was significantly shorter with prochlorperazine (P =.021). There were significantly fewer treatment failures with prochlorperazine (P =.03, 9.5% versus 31%; difference 21%, 95% confidence interval 5 to 38). There was no difference in incidence of extrapyramidal effects. Prochlorperazine caused significantly fewer complaints of sleepiness (P =.002, 38% versus 71%; difference 33%, 95% confidence interval 13 to 53; P =.002). CONCLUSION: Prochlorperazine works significantly better than promethazine for relieving symptoms of nausea and vomiting more quickly and completely in ED patients with uncomplicated nausea and vomiting.

Adolescent↗
PubMedDate not supplied

Optimizing treatment and outcomes in acute heart failure: beyond initial triage.

Heart failure contributes substantially to health care costs in the United States due to its prevalence and frequent necessity for repeat hospitalizations to manage episodes of acute decompensation. Heart failure overwhelmingly impacts Medicare costs, as the highest proportion of heart failure patients are older than 65 years of age. Efforts to reduce morbidity, mortality, and health care resource utilization have been achieved successfully through emergency department-based heart failure observation units. For select patients, the observation unit can provide care with effective oral agents, including angiotensin-converting enzyme inhibitors, beta-adrenergic receptor blockers, and diuretics, as well as administration of other vasoactive agents, followed by a discharge plan of effective heart failure education and rigorous follow-up management. As advanced pharmacologic and diagnostic therapies continue to emerge, the observation unit staff can play an integral role in the critical education and self-management tools that are needed by the patient to ultimately improve outcomes and quality of life.

Acute Disease↗