Annals of emergency medicine
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Sgarbossa's rule, proposed for the diagnosis of acute myocardial infarction in the presence of left bundle branch block, has had suboptimal diagnostic utility. We hypothesize that a revised rule, in which the third Sgarbossa component (excessively discordant ST-segment elevation as defined by ≥5 mm of ST-segment elevation in the setting of a negative QRS) is replaced by one defined proportionally by ST-segment elevation to S-wave depth (ST/S ratio), will have better diagnostic utility for ST-segment elevation myocardial infarction (STEMI) equivalent, using documented coronary occlusion on angiography as reference standard. ⋯ Replacement of the absolute ST-elevation measurement of greater than or equal to 5 mm in the third component of the Sgarbossa rule with an ST/S ratio less than -0.25 greatly improves diagnostic utility of the rule for STEMI. An unweighted rule using this criterion resulted in excellent prediction for acute coronary occlusion.
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In 2005, England implemented a controversial target limiting patient stays in the emergency department (ED) to 4 hours. We determine the effect of the "4-hour target" on quality of care and resource use. ⋯ England's 4-hour target did not appear to have a negative effect on quality or safety of ED care and had little effect on test use.
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This study examines whether symptoms reported by patients presenting with possible acute coronary syndrome vary across different ethnic backgrounds. We also assess the predictive value of individual symptoms according to ethnic background. ⋯ There are cross-cultural differences in symptoms reported by patients with suspected acute coronary syndrome. Such differences are not likely to be clinically relevant because the majority of symptoms display limited diagnostic value for acute coronary syndrome.