Rogg Jonathan G, De Neve Jan-Walter, Huang Calvin, Brown David, Jang Ik-Kyung, Chang Yuchiao, Marill Keith, Parry Blair, Hoffmann Udo, Nagurney John T
Tufts University School of Medicine, Boston, Massachusetts, USA.
J Emerg Med. 2011 Feb;40(2):128-34. doi: 10.1016/j.jemermed.2008.02.031. Epub 2008 Sep 14.
To measure the degree of overlap and diagnostic yield for evaluations of acute coronary syndrome (ACS), pulmonary embolism (PE), and aortic dissection (AD) among Emergency Department (ED) patients.
We conducted a cross-sectional descriptive study of consecutive adult patients seen in the ED of a 78,000-annual-visit urban academic medical center. Patients who had received at least one of eight of the tests used in our ED to diagnose these three diseases were identified through three methods, and a final study population list was created. Overlap of evaluations and diagnostic yields were calculated by simple descriptive statistics.
Over a 2-week period, 626 patient encounters among 622 unique patients were identified. Among these 626 visits, 139 (22%) included diagnostic tests for more than one of the three diagnoses of interest. The majority of these multiple tests were for ACS plus PE (n = 121, 87% of all multiple tests), whereas a minority of patients received tests for ACS plus AD (n = 14, 10% of all multiple tests) or for the "triple work-up" of ACS plus PE plus AD (n = 4, 2.9% of all multiple tests).
Although the "triple work-up" evaluation for ACS, PE, and AD is relatively uncommon, a significant number of ED patients who are evaluated for at least one of these three major chest pain syndromes receive simultaneous testing for one of the others.
测量急诊科（ED）患者中急性冠状动脉综合征（ACS）、肺栓塞（PE）和主动脉夹层（AD）评估的重叠程度和诊断率。
我们对一家年就诊量达78000人次的城市学术医疗中心急诊科的连续成年患者进行了横断面描述性研究。通过三种方法确定了在我们急诊科用于诊断这三种疾病的八项检查中至少接受过一项检查的患者，并创建了最终的研究人群列表。通过简单的描述性统计计算评估的重叠程度和诊断率。
在为期2周的时间里，共识别出622名独特患者的626次就诊情况。在这626次就诊中，139次（22%）包括对三种相关诊断中不止一种的诊断测试。这些多项测试中的大多数是针对ACS加PE（n = 121，占所有多项测试的87%），而少数患者接受了ACS加AD的测试（n = 14，占所有多项测试的10%）或针对ACS加PE加AD的“三联检查”（n = 4，占所有多项测试的2.9%）。
尽管对ACS、PE和AD进行“三联检查”的评估相对不常见，但大量因这三种主要胸痛综合征中至少一种接受评估的急诊科患者同时接受了其他一种疾病的检测。
