Sandrine Charpentier1,2, Sebastien Beaune3,4, Luc Marie Joly5, Abdo Khoury6,7, François-Xavier Duchateau8,9,10, Raphael Briot11, Bertrand Renaud12, François-Xavier Ageron13,14. 1. Emergency Department, Toulouse Rangueil University Hospital. 2. INSERM UMR 1027 Team 5, University Toulouse III Paul Sabatier, Toulouse. 3. Department of Emergency Medicine, Ambroise Paré Hospital, Assistance Publique - Hopitaux de Paris. 4. INSERM UMR-S 1144. 5. Emergency Department, CHU De Rouen, Hôpital Charles Nicolle, Rouen University, Rouen. 6. Department of Emergency Medicine and Critical Care. 7. INSERM CIC-1431, University of Franche-Comté-Medical Centre, Besançon. 8. INSERM UMR 1153, Université Paris Diderot. 9. Centre de Recherche Epidémiologies et Biostatistique Sorbonne Paris Cité, Paris. 10. Service Mobile d'Urgences et Réanimation, AP-HP Hôpital Beaujon, Université Paris 7, Clichy. 11. UMR-CNRS 5525, Department of Emergency Medicine, Grenoble Alpes University Hospital, Grenoble. 12. Emergency Department, Henri-Mondor Hospital-UPEC, Créteil. 13. Department of Emergency Medicine, SAMU 74, Annecy Genevois Hospital. 14. Northern French Alps Emergency Network, Department of Public Health, Annecy Genevois Hospital, Annecy, France.
Abstract
OBJECTIVE: The aim of this paper was to describe the epidemiology, and diagnostic and therapeutic strategies that emergency physicians use to manage patients presenting with chest pain at all three levels of the French emergency medical system - that is, dispatch centres (SAMUs: the medical emergency system), which operate the mobile intensive care units (MICUs), and hospitals' emergency departments (EDs), with a focus on acute coronary syndrome (ACS). PATIENTS AND METHODS: All patients with chest pain who contacted a SAMU and/or were managed by a MICU and/or were admitted into an ED were included in a 1-day multicentre prospective study carried out in January 2013. Data on diagnostic and therapeutic management and disposition were collected. An in-hospital follow-up was performed. RESULTS: In total, 1339 patients were included: 537 from SAMU, 187 attended by a MICU and 615 in EDs. Diagnosing ACS was the main diagnostic strategy of the French emergency care system, diagnosed in 16% of SAMU patients, 25% of MICU patients and 10% of ED patients. Among patients calling the SAMU, 76 (14%) received only medical advice, 15 (8%) patients remained at home after being seen by a MICU and 454 (74%) were discharged from an ED. CONCLUSION: Management of chest pain at the three levels of the French medical emergency system is mainly oriented towards ruling out ACS. The strategy of diagnostic management is based on minimizing missed diagnoses of ACS.
OBJECTIVE: The aim of this paper was to describe the epidemiology, and diagnostic and therapeutic strategies that emergency physicians use to manage patients presenting with chest pain at all three levels of the French emergency medical system - that is, dispatch centres (SAMUs: the medical emergency system), which operate the mobile intensive care units (MICUs), and hospitals' emergency departments (EDs), with a focus on acute coronary syndrome (ACS). PATIENTS AND METHODS: All patients with chest pain who contacted a SAMU and/or were managed by a MICU and/or were admitted into an ED were included in a 1-day multicentre prospective study carried out in January 2013. Data on diagnostic and therapeutic management and disposition were collected. An in-hospital follow-up was performed. RESULTS: In total, 1339 patients were included: 537 from SAMU, 187 attended by a MICU and 615 in EDs. Diagnosing ACS was the main diagnostic strategy of the French emergency care system, diagnosed in 16% of SAMU patients, 25% of MICU patients and 10% of ED patients. Among patients calling the SAMU, 76 (14%) received only medical advice, 15 (8%) patients remained at home after being seen by a MICU and 454 (74%) were discharged from an ED. CONCLUSION: Management of chest pain at the three levels of the French medical emergency system is mainly oriented towards ruling out ACS. The strategy of diagnostic management is based on minimizing missed diagnoses of ACS.
Authors: Julian T Hertz; Godfrey L Kweka; Gerald S Bloomfield; Alexander T Limkakeng; Zak Loring; Gloria Temu; Blandina T Mmbaga; Charles J Gerardo; Francis M Sakita Journal: Glob Heart Date: 2020-02-06
Authors: Enrico Ammirati; Maria Frigerio; Leslie T Cooper; Paolo G Camici; Eric D Adler; Cristina Basso; David H Birnie; Michela Brambatti; Matthias G Friedrich; Karin Klingel; Jukka Lehtonen; Javid J Moslehi; Patrizia Pedrotti; Ornella E Rimoldi; Heinz-Peter Schultheiss; Carsten Tschöpe Journal: Circ Heart Fail Date: 2020-11-12 Impact factor: 8.790