ObjectiveTo evaluate the prognosis factors for early death (within 60 days) of acute myocardial infarction (AMI) patients for early identification and prevention of the disease. MethodsWe analyzed the information of AML patients who were admitted to the emergency department between May 2009 and July 2010, and analyzed their clinical data, such as gender, age, prehospital time, myocardial enzyme, electrocardiogram, complications, whether the patients had thrombolysis therapy, time of thrombolysis, end point observation and time of death, ect. Cox multivariate survival analysis was performed with the use of SPSS 18.0 software. ResultsSeventy-one cases were collected with one of them excluded for fragmented data. After analysing, we found that patients' age and isoenzymes of creatine kinase (CK-MB) level were prognosis factors for early death. Further analysis showed that the relative risk (RR) of age was 1.166 (P=0.023), and the RR of CK-MB was 1.001 (P=0.004). ConclusionPatients' age has predictive value for early death of AML. More attention should be paid to AML patients with advanced age. Detecting myocardial enzymes levels, especially the CK-MB level, is significant for predicting early death. Other indicators need to be further explored due to the possible limitation of our study.
ObjectiveTo find out the possible factors that may affect the survival time of patients undergoing return of spontaneous circulation (ROSC) within seven days of cardio-pulmonary resuscitation. MethodWe retrospectively collected 20 clinical indicators from 51 patients who underwent ROSC after cardio-pulmonary resuscitation in Emergency Department between August 2013 and February 2015. The indicators included gender, age, duration of cardio-pulmonary resuscitation, blood pressure acquired immediately after ROSC, heart rate, respiration, lactic acid, creatinine, prothrombin time, bilirubin, pH, arterial partial pressure of carbon dioxide, potassium, sodium, blood glucose, atrial natriuretic peptides, leukocyte, platelets, and hemoglobin. Then we analyzed the correlation of these indicators with survival time through Cox regression model. ResultsThe results showed that duration of cardiopulmonary resuscitation[RR=1.053, 95% CI (1.020, 1.088), P=0.002] and systolic blood pressure acquired immediately after ROSC[RR=0.991, 95% CI (0.982, 0.999), P=0.038] significantly affected the survival time of patients after ROSC. ConclusionsDuration of cardiopulmonary resuscitation and systolic blood pressure acquired immediately after ROSC may be useful in predicting the survival time of patients after ROSC.
ObjectiveTo systematically review the diagnostic value of procalcitonin (PCT) for tuberculous pleural effusion. MethodsWe electronically searched CNKI, WanFang Data, VIP, CBM, PubMed, The Cochrane Library and EMbase from inception to April, 2013, to collect the literature about the diagnostic value of PCT for tuberculous pleural effusion compared with gold standard (positive outcomes of mycobacterium tuberculosis culture). Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. MetaDiSc 1.4 were used to conduct the meta-analysis. ResultsEight studies were finally included. The results of meta-analysis showed the pooled sensitivity and specificity were 0.63 (95%CI 0.58 to 0.68) and 0.76 (95%CI 0.70 to 0.81), respectively. The positive likelihood ratio and negative likelihood ratio were 2.72 (95%CI 1.48 to 5.02) and 0.49 (95%CI 0.29 to 0.82), respectively. The diagnostic odds ratio (DOR) was 5.77 (95%CI 1.89 to 17.58). And the SROC AUC was 0.79. Heterogeneity was mainly derived from the QUADAS score and Begg's test showed there was no presence of publication bias. ConclusionPCT is a potential marker in the diagnosis of benign and tuberculous pleural effusion, which can be used to determine diagnosis identification of tuberculous pleural effusion.
ObjectiveTo systematically review the diagnostic value of neuron specific enolase (NSE) for malignant pleural effusion. MethodsWe comprehensively searched databases including The Cochrane Library (Issue 1, 2012), EMbase, MEDLINE, CBM, CNKI, WanFang Data and VIP from inception to January 2012 to collect studies about the diagnostic value of NSE for malignant pleural effusion. Literature screening according to the inclusion and exclusion criteria, data extraction and methodological quality assessment were completed by two reviewers independently. Then Meta-DiSc software (version 1.4) was used for pooling analysis. ResultsA total of 12 studies were finally included. The results of meta-analysis showed that the value of pooled specificity, sensitivity, positive likelihood radio, negative likelihood radio and diagnostic odds ratio (DOR) were 0.79 (0.76 to 0.84), 0.55 (0.51 to 0.59), 3.2 (1.94 to 5.29), 0.58 (0.45 to 0.74), 7.56 (3.74 to 15.30), respectively; and the area under SROC curve (AUC) was 0.813 1. ConclusionUsing NSE as a maker to diagnose malignant pleural effusion is of certain clinical value, which is used to differentiate benign and malignant pleural effusion.
ObjectiveTo investigate the effect of using hemoglobin-revised trauma score (HB-RTS) on predicting mortality risk in trunk injury patients. MethodsAccording to case control study rules, medical records of patients with trunk injury who were treated between July 2011 and October 2013, were collected. Patients were divided into two groups according to their survival prognosis within 28 days. The HB-RTS, revised trauma score (RTS), and injury severity score (ISS) of the two groups were calculated. The receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) and Youden's index were calculated. And then, we selected the optimal cutoff value using HB-RTS and RTS to predict the trunk injury patients' mortality and calculated their sensitivity, specificity, and accuracy. In the end, the correlation of ISS with HB-RTS and RTS using linear correlation analysis method was analyzed. ResultsBesides RTS, HB-RTS and ISS in the death group were statistically significant higher than that in the survival group. The AUC of HB-RTS and RTS of the two groups were 0.922 and 0.888, respectively. The sensitivity of HB-RTS and RTS were 91.5% and 83%; and the specificity of HB-RTS and RTS were 95.7% and 76.6%, respectively. The correlation of HB-RTS and ISS was -0.592, while the correlation of RTS and ISS was 0.585. ConclusionCompared to RTS, ROC of HB-RTS is enlarged, the specificity is increased, and the sensitivity is decreased. HB-RTS has stronger correlation with ISS than with RTS. The predictive effect of HB-RTS is higher than RTS in predicting mortality of trunk injury patients.
ObjectiveTo explore the possible association between early injury assessment indexes and the length of stay (LOS) in first-line hospitals, in order to help the hospitals take advantage of resource effectively and transfer victims reasonably during earthquakes. MethodWe retrospectively analyzed the medical information of 3 576 traumatic patients injured in the Wenchuan Earthquake who were transferred to 242 first-line medical institutes between 14:28, May 12th and 14:30, May 19th in 2008. Three kinds of 15 variables were extracted for the analysis, including gender, age, heart or lung disease, pre-hospital time, head injury, trunk injury, open injury, crush injury, asphyxia, body temperature, heart rate, respiration, systolic blood pressure, diastolic blood pressure, and Glasgow coma score. Multiple stepwise linear regression analysis was performed to identify the factors associated with LOS. ResultsThe multiple linear regression analysis showed that age as well as other six factors affected LOS significantly (P<0.05). The partial regression coefficients of age, pre-hospital time, head injury, trunk injury, crush injury, complication of cardiac or pulmonary disease, and Glasgow coma score were -0.062, 0.157, 3.703, 4.111, 12.602, 14.762 and -1.312, respectively. ConclusionsEarthquake trauma patients with older age, long pre-hospital time, head injury, trunk injury, heart or lung disease, crush injury, and lower Glasgow coma score are at increased risk for extended LOS.
ObjectiveTo identify the clinical features of and risk factors for allergic reaction to bee stings in Sichuan. MethodWe retrospectively analyzed the clinical data of 387 patients with bee stings admitted to the Emergency Department of nine hospitals in Sichuan during January 1, 2010 to December 31, 2011, and evaluated the risk factors for bee sting anaphylaxis with logistic regression analysis, and explored the influence of anaphylaxis on death with Fisher exact probability method. ResultsAmong the 387 patients with bee stings, 41 (10.6%) had allergic reactions. The age in patients from the anaphylaxis group was significantly older than those in the non-anaphylaxis group (P<0.05). Logistic regression analysis showed that age was an independent risk factor for allergic reaction in patients with bee stings[OR=0.983, 95%CI (0.967, 0.999), P=0.042]. All the patients with allergic reactions were prescribed with systemic corticosteroids, and 16 were prescribed with antihistamine drugs, but no patients were prescribed with epinephrine. Among the 16 patients with systemic allergic reaction, 12 were given less than 1000 mL intravenous rehydration per 24 h, 2 were given 1000-3000 mL intravenous rehydration, and only 2 were given more than 3 000 mL intravenous rehydration. The mortality of allergic patients was significantly higher than that of the non-allergic group (9.8% vs 1.4%, P<0.05). ConclusionsThe mortality of anaphylaxis patients is significantly higher than that of the non-anaphylaxis group. Age is an independent risk factor for allergic reactions to bee stings. Treatment of bee stings related to severe allergic reaction needs to be further standardized.
ObjectiveTo evaluate prehospital treatment strategies of rescuers and first-line hospitals for thoracic trauma victims after Lushan earthquake, and provide reference for making emergency response plans, staff training, and preparedness of material and human resources for future disasters. MethodsClinical data of 365 victims in Lushan '4.20' earthquake who received treatment in West China Hospital were retrospectively analyzed. Among them, 63 victims had thoracic trauma, including 40 males (63.5%)and 23 females (36.5%)with their age of 49.08±19.10 years. There were 244 victims with orthopedic trauma, including 133 males (54.5%)and 111 females (45.4%)with their age of 41.59±22.74 years. Prehospital treatment methods (including specific treatment and general treatment)were compared between thoracic trauma victims and orthopedic trauma victims. ResultsAmong all the thoracic trauma victims, 51 victims required specific pre-hospital treatment, but only 10 (19.6%)victims actually received it. Among all the orthopedic trauma victims, 220 victims required specific prehospital treatment, but actually 162 (73.6%)victims received it. The percentages of thoracic and orthopedic victims who received specific prehospital treatment were statistically different (P < 0.01). There was no statistical difference in the percentage of victims who received general treatment between thoracic and orthopedic trauma victims (P > 0.05). ConclusionsThoracic trauma victims receive less specific prehospital treatment than orthopedic trauma victims from rescuers and first-line hospitals after Lushan earthquake. More specific prehospital treatment is needed for thoracic trauma victims in disaster rescue in the future.
ObjectiveTo systematically review the diagnostic accuracy of C-arm cone-beam CT (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB) for lung nodules. MethodsWe electronically searched databases including PubMed, EMbase, EBSCO, Ovid, CBM, VIP, WanFang Data and CNKI from inception to Feb 28th, 2015, to collect diagnostic studies of CBCT-guided PTNB for lung nodules. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies by QUADAS-1 tool. Then, meta-analysis was performed by Stata 12.0 and Meta-DiSc 1.4 softwares for calculating pooled sensitivity (Sen), specificity (Spe), positive likelihood ration (+LR), negative likelihood ration (-LR), and diagnostic odds ratio (DOR), drawing summary receiver operating characteristic (SROC) curve and estimating area under the curve (AUC). ResultsA total of 9 studies involving 1 815 patients were included. The results of meta-analysis showed that the pooled Sen, Spe, +LR,-LR, and DOR were 0.95 (95%CI 0.92 to 0.96), 1.00 (95%CI 0.66 to 1.00), 2 076.58 (95%CI 1.8 to 2.3e+0.6), 0.05 (95%CI 0.04 to 0.08), and 39 443.88 (95%CI 30.53 to 5.1e+0.7), respectively. The AUC of SROC was 0.97 (95%CI 0.95 to 0.98). ConclusionCBCT-guided PTNB can be used as one of the primary examination approaches for lung nodules with relatively high diagnostic accuracy. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.