Seronde Marie-France, Laribi Said, Collins Sean P, Deye Nicolas, Logeart Damien, Plaisance Patrick, Cohen-Solal Alain, Mebazaa Alexandre
aUMR-S 942 Inserm bDepartment of Emergency Medicine cIntensive Care Unit dDepartment of Cardiology eDepartment of Anesthesiology and Intensive Care fParis Diderot University, Sorbonne Paris Cité gDHU FIRE, Paris Diderot University hAPHP, Saint Louis Lariboisière University Hospitals, Paris iDepartment of Cardiology, EA3920, University Hospital Jean Minjoz, Besancon, France jDepartment of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.
Eur J Emerg Med. 2016 Jun;23(3):179-84. doi: 10.1097/MEJ.0000000000000247.
Acute heart failure (AHF) is frequently encountered in the emergency department (ED) or in the cardiac care unit (CCU)/ICU. Discrimination between cardiac and noncardiac cause of dyspnea by clinical means and standard testing is sometimes inadequate. The aim of our study was to assess AHF diagnosis agreement as determined by: (a) the attending physician, (b) the hospital discharge diagnosis, and (c) an adjudication committee.
Between 2010 and 2011, consecutive patients arriving for dyspnea in our hospital were prospectively included. A convenience sample of patients was enrolled in this analysis. Patients were admitted through the ED (280 patients) or through CCU/ICU (112 patients) for undifferentiated dyspnea.
Overall, few differences were observed between the initial diagnosis and the hospital discharge diagnosis or the adjudicated diagnosis. Among the 200 patients with an initial diagnosis of AHF, hospital discharge diagnosis confirmed AHF (alone or combined) in 191 (95.5%) patients and the adjudication committee confirmed AHF (alone or combined) in 196 (98%) patients.
Our study showed considerable agreement between different AHF diagnostic standards. An initial AHF diagnosis on the basis of clinical signs and biological parameters utilizing B-type natriuretic peptide testing has high agreement and accuracy with the hospital discharge and adjudicated diagnosis of AHF. The present study also shows that the accuracy of the initial AHF diagnosis allows rapid inclusion in AHF trials. These results, if confirmed in a broader cohort of patients, suggest that the initial ED diagnosis is highly accurate and reliable to guide further inpatient management.
急性心力衰竭（AHF）在急诊科（ED）或心脏监护病房（CCU）/重症监护病房（ICU）中经常遇到。通过临床手段和标准检测来区分呼吸困难的心脏性和非心脏性病因有时并不充分。我们研究的目的是评估由以下因素确定的AHF诊断一致性：（a）主治医生，（b）医院出院诊断，以及（c）一个裁决委员会。
在2010年至2011年期间，前瞻性纳入了我院因呼吸困难前来就诊的连续患者。本分析纳入了一个便利样本患者。患者因未分化的呼吸困难通过急诊科（280例患者）或CCU/ICU（112例患者）入院。
总体而言，初始诊断与医院出院诊断或裁决诊断之间观察到的差异很少。在200例初始诊断为AHF的患者中，医院出院诊断确认AHF（单独或合并）的有191例（95.5%）患者，裁决委员会确认AHF（单独或合并）的有196例（98%）患者。
我们的研究表明不同的AHF诊断标准之间具有相当高的一致性。基于临床体征和利用B型利钠肽检测的生物学参数进行的初始AHF诊断与AHF的医院出院诊断和裁决诊断具有高度的一致性和准确性。本研究还表明初始AHF诊断的准确性允许快速纳入AHF试验。如果在更广泛的患者队列中得到证实，这些结果表明初始的急诊科诊断对于指导进一步的住院管理具有高度的准确性和可靠性。
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