Journal Reviews
Kontos MC, Anderson P, Ornato JP. Utility of troponin I in patients with cocaine-associated chest pain. Acad Emerg Med 2002; 9:1,007-1,013.
Troponin is equally useful as creatine kinase (CK)-MB in diagnosing necrosis in patients with cocaine-associated chest pain and possible myocardial infarction (MI), says this study from Medical College of Virginia Hospitals in Richmond.
The researchers examined outcomes in 246 patients who were admitted for possible MI after cocaine use. Over eight hours, all the patients underwent serial sampling of CK-MB and cardiac troponin I. Of this group, 34 patients (14%) met CK-MB criteria for MI, and 38 (16%) had cardiac troponin I elevations. Angiography was performed in 29 of these 38 patients, and significant disease was present in 25 (86%).
The researchers note that initial electrocardiogram and clinical factors are less useful for identifying MI in patients when recent cocaine use is a factor, which underscores the importance of using myocardial markers in this group. The researchers reported that most patients with cardiac troponin I elevations met CK-MB criteria for MI or had significant underlying coronary disease. "Troponin appears to have an equivalent diagnostic accuracy compared with CK-MB for diagnosing necrosis in patients with cocaine-associated chest pain and suspected MI," they conclude.
Irons MJ, Farace E, Brady WJ, et al. Mental status screening of emergency department patients: Normative study of the Quick Confusion Scale. Acad Emerg Med 2002; 9:989-994.
A six-item scale is an effective way to screen emergency department (ED) patients for impaired mental status, says this study from the University of Virginia Health System in Charlottesville. During a nine-week period in 2000, the Quick Confusion Scale (QCS) was given to 731 adult ED patients. The following was said to patients, and correct answers were designated to receive a score of 1 or 2:
- What year is it now?
- What month is it?
- Repeat this phrase after me and remember it: John Brown, 42 Market St., New York.
- About what time is it?
- Count backward from 20 to one.
- Say the months in reverse.
- Repeat the memory phrase.
All individuals scoring less than the best possible score of 15 (a total of 295 patients) also were given the Mini-Mental State Examination (MMSE), and results correlated within acceptable limits. The researchers argue that altered mental status often goes underrecognized and has direct implications for patient care in the ED. They explain that the QCS was developed to address time constraints and physical limitations of ED physicians.
The five- to 15-minute administration time of the MMSE too often exceeds the time physicians are able to spend on that aspect of the examination, and it requires physicians to provide patients with a pen, paper, and writing surface, say the researchers, whereas the QCS takes about two and a half minutes and requires no testing materials for the patient, since no written response is required.
The study’s findings indicate that the QCS is an effective alternative to the MMSE, according to the research-ers. "The QCS, in its focus on providing a quickly obtained, easily calculated, and readily interpreted score, presents a viable alternative to currently existing practices for assessing mental status," they conclude.
Cole FL, Kuensting LL, MacLean S, et al. Advanced practice nurses in emergency care settings: A demographic profile. J Emerg Nurs 2002; 28:414-419.
The majority of advanced practice nurses (APNs) hold a master’s degree, are certified, and provide services to both the ED and the fast track, says this study sponsored by the Des Plaines, IL-based Emergency Nurses Association. A total of 166 APNs (clinical nurse specialists or nurse practitioners) who work in EDs were surveyed about their education, experience, certification, and practice area. Here are key findings:
— Before becoming advanced practice nurses, they worked an average of 11.1 years as ED nurses.
— The advanced practice nurses worked mostly in urban facilities, with 50.9% working in urban areas, 32% in suburban, and 17% in rural areas.
— The APNs worked in the ED and fast track. "From an economic standpoint, it makes sense to have APNs who can provide health care and facilitate the efficient movement of patients in both areas," wrote the researchers.
— The majority of clinical nurse specialists were certified in critical care or medical-surgical nursing, and the majority of nurse practitioners were certified as family nurse practitioners.
— The APNs surveyed practiced in one to nine EDs, with an average of 1.7. The researchers suggest the APNs are working at multiple EDs because of merging of area of hospitals, and because of employment by physician groups that provide services at more than one ED.
"Continuing research is needed to identify the most effective utilization of APNs, document their contributions to patient care and outcomes, identify their continuing educational needs, and monitor the changing demographics of APNs in emergency care settings," the researchers state.
Utility of troponin I in patients with cocaine-associated chest pain; Mental status screening of emergency department patients: Normative study of the Quick Confusion Scale; Advanced practice nurses in emergency care settings: A demographic profile
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