Department of Endocrine and Metabolic Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, San Luca Hospital, Piazzale Brescia 20, 20149, Milan, Italy.
Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy.
Intern Emerg Med. 2022 Nov;17(8):2379-2389. doi: 10.1007/s11739-022-03071-0. Epub 2022 Aug 25.
Thyroid dysfunctions are highly prevalent and can worsen underlying cardiopathies, but despite that the routine screening of thyroid function in the Emergency Department (ED) setting is not generally recommended.
To understand if staff training and implementation of rapid TSH screening (rTSH) could improve the management of patients arrived in the ED. Specifically, we aimed at evaluating the prevalence of undiagnosed thyroid diseases among ED patients; the effects of educational meetings in the clinical decision-making process; the usefulness of rTSH, in terms of variation of either the clinical work out or the existing treatment.
Retrospective case-control study of 9227 patients managed in the ED of an academic institution. rTSH was routinely available for all patients, who were divided into rTSH-YES and rTSH-NO groups.
We included 4243 and 4984 patients in the rTSH-YES and rTSH-NO group, respectively. Trained personnel uncovered a high prevalence of undiagnosed thyroid dysfunction (7%). The diagnosis in the ED of heart failure, history of thyroid diseases, contrast media/amiodarone administration and female gender were independently associated with an increased likelihood to have thyroid dysfunction. The rTSH improved the clinical outcome by (a) appropriate treatment of an underlying clinical condition causing ED entrance, (b) appropriate prophylaxis in patients requiring contrast media, (c) uncovering incorrect treatments, with 60% of patients on levothyroxine requiring a dose reduction.
The rTSH in the ED revealed a high prevalence of untreated thyroid disorders with a major impact on following interventions. The training of a multidisciplinary team is crucial in driving the correct decision-making process.
甲状腺功能障碍非常普遍，可能会使潜在的心脏病恶化，但尽管如此，一般不建议在急诊科常规筛查甲状腺功能。
了解员工培训和实施快速 TSH 筛查（rTSH）是否可以改善急诊科患者的管理。具体而言，我们旨在评估急诊科患者中未确诊甲状腺疾病的患病率；教育会议对临床决策过程的影响；rTSH 在改变临床工作或现有治疗方面的有效性。
对一家学术机构急诊科的 9227 例患者进行回顾性病例对照研究。所有患者均常规进行 rTSH 检查，分为 rTSH-YES 和 rTSH-NO 组。
我们纳入了 rTSH-YES 和 rTSH-NO 组的 4243 例和 4984 例患者。经过培训的人员发现未确诊甲状腺功能障碍的患病率很高（7%）。心力衰竭、甲状腺疾病史、造影剂/胺碘酮的使用和女性性别是与甲状腺功能障碍发生相关的独立因素。rTSH 通过以下方式改善了临床结局：（a）对导致急诊科就诊的潜在临床疾病进行适当治疗；（b）对需要造影剂的患者进行适当预防；（c）发现不正确的治疗，其中 60%正在服用左甲状腺素的患者需要减少剂量。
rTSH 在急诊科发现了大量未经治疗的甲状腺疾病，对后续干预措施有重大影响。多学科团队的培训对于推动正确的决策过程至关重要。
