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  1. Article ; Online: Trial is error? Evaluating the effectiveness of single-troponin diagnostic pathways.

    Body, Richard

    Heart (British Cardiac Society)

    2021  Volume 107, Issue 9, Page(s) 690–691

    MeSH term(s) Biomarkers/blood ; Humans ; Myocardial Infarction/blood ; Myocardial Infarction/diagnosis ; Troponin/blood
    Chemical Substances Biomarkers ; Troponin
    Language English
    Publishing date 2021-02-10
    Publishing country England
    Document type Editorial
    ZDB-ID 1303417-0
    ISSN 1468-201X ; 1355-6037
    ISSN (online) 1468-201X
    ISSN 1355-6037
    DOI 10.1136/heartjnl-2020-318704
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    ab Jg. 2022: Lesesaal (EG)
    Zs.MO 112: Show issues

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  2. Article ; Online: Accuracy or efficiency? Striking the balance for your chest pain pathway.

    Body, Richard

    Heart (British Cardiac Society)

    2020  Volume 106, Issue 13, Page(s) 954

    MeSH term(s) Chest Pain/diagnosis ; Chest Pain/etiology ; Humans ; Myocardial Infarction ; Risk Assessment
    Keywords covid19
    Language English
    Publishing date 2020-05-13
    Publishing country England
    Document type Editorial ; Comment
    ZDB-ID 1303417-0
    ISSN 1468-201X ; 1355-6037
    ISSN (online) 1468-201X
    ISSN 1355-6037
    DOI 10.1136/heartjnl-2020-316810
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.MO 112: Show issues

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  3. Article ; Online: Incentivising the rapid diagnosis of acute coronary syndromes in England and Wales.

    Body, Richard

    European journal of emergency medicine : official journal of the European Society for Emergency Medicine

    2020  Volume 27, Issue 4, Page(s) 237–238

    MeSH term(s) Acute Coronary Syndrome/diagnosis ; England ; Humans ; Motivation ; Myocardial Infarction ; Wales
    Language English
    Publishing date 2020-05-20
    Publishing country England
    Document type Journal Article
    ZDB-ID 1233544-7
    ISSN 1473-5695 ; 0969-9546
    ISSN (online) 1473-5695
    ISSN 0969-9546
    DOI 10.1097/MEJ.0000000000000706
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    Zs.A 4264: Show issues Location:
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  4. Article ; Online: Declining Emergency Medicine publications from the UK: the glass is half empty and may be leaking.

    Body, Richard

    Emergency medicine journal : EMJ

    2020  Volume 37, Issue 6, Page(s) 323

    MeSH term(s) Emergency Medicine/education ; Emergency Medicine/instrumentation ; Emergency Medicine/methods ; Humans ; Publications/standards ; Publications/statistics & numerical data ; United Kingdom
    Language English
    Publishing date 2020-04-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 2040124-3
    ISSN 1472-0213 ; 1472-0205
    ISSN (online) 1472-0213
    ISSN 1472-0205
    DOI 10.1136/emermed-2020-209650
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    Zs.A 1941: Show issues Location:
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  5. Article ; Online: Two troponins, one troponin, none… the dawn of troponin-less decision aids.

    Body, Richard / De Wit, Kerstin

    CJEM

    2022  Volume 24, Issue 1, Page(s) 7–8

    MeSH term(s) Decision Support Techniques ; Humans ; Myocardial Infarction ; Troponin ; Troponin T
    Chemical Substances Troponin ; Troponin T
    Language English
    Publishing date 2022-01-17
    Publishing country England
    Document type Editorial ; Research Support, Non-U.S. Gov't ; Comment
    ISSN 1481-8043
    ISSN (online) 1481-8043
    DOI 10.1007/s43678-021-00251-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Acute coronary syndromes diagnosis, version 2.0: Tomorrow's approach to diagnosing acute coronary syndromes?

    Body, Richard

    Turkish journal of emergency medicine

    2018  Volume 18, Issue 3, Page(s) 94–99

    Abstract: Chest pain accounts for approximately 6% of Emergency Department (ED) attendances and is the most common reason for emergency hospital admission. For many years, our approach to diagnosis has required patients to stay in hospital for at least 6-12 h to ... ...

    Abstract Chest pain accounts for approximately 6% of Emergency Department (ED) attendances and is the most common reason for emergency hospital admission. For many years, our approach to diagnosis has required patients to stay in hospital for at least 6-12 h to undergo serial biomarker testing. As less than one fifth of the patients undergoing investigation actually has an acute coronary syndrome (ACS), there is tremendous potential to reduce unnecessary hospital admissions. Recent advances in diagnostic technology have improved the efficiency of care pathways. Decision aids such as the Thrombolysis in Myocardial Infarction (TIMI) risk score and the History, Electrocardiogram, Age, Risk factors and Troponin (HEART) score enable rapid 'rule out' of ACS within hours of patients arriving in the ED. With high sensitivity cardiac troponin (hs-cTn) assays, approximately one third of patients can have ACS 'ruled out' with a single blood test, and up to two thirds could have an acute myocardial infarction 'ruled out' with a second sample taken after as little as 1 h. Building on those recent advances, this paper presents an overview of the principles behind the development of the Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid. This clinical prediction model could be used to 'rule out' and 'rule in' ACS following a single blood test and to calculate the probability of ACS for every patient. The future potential of this approach is then addressed, including practical applications of artificial intelligence, shared decision making, near-patient testing and personalized medicine.
    Language English
    Publishing date 2018-07-13
    Publishing country India
    Document type Journal Article ; Review
    ISSN 2452-2473
    ISSN 2452-2473
    DOI 10.1016/j.tjem.2018.05.005
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  8. Article ; Online: Manchester ACS Electrocardiograph Model for the Identification of Non-STEMI in the ED.

    Fitzpatrick, Niall / Body, Richard

    The American journal of emergency medicine

    2022  Volume 57, Page(s) 27–33

    Abstract: Objective: Acute coronary syndromes (ACS) are a diagnostic challenge for Emergency Medicine (EM) clinicians. To help clinicians assess patients with non-ST-elevation ACS (NSTEACS), clinical decision aids have been developed, combining clinical history, ... ...

    Abstract Objective: Acute coronary syndromes (ACS) are a diagnostic challenge for Emergency Medicine (EM) clinicians. To help clinicians assess patients with non-ST-elevation ACS (NSTEACS), clinical decision aids have been developed, combining clinical history, cardiac troponin and the electrocardiograph (ECG). These models ask the clinician to subjectively assess the ECG variable, introducing reliability issues. We set out to derive an ECG model that would provide an objective measure for ischaemia using non-ST-elevation myocardial infarction (NSTEMI) as the primary outcome.
    Methods: We derived an ECG model in a retrospective Emergency Department cohort using logistic regression with a primary outcome of NSTEMI. All patients presented with signs or symptoms suggestive of an ACS. The model was validated in a multi-centre prospective Emergency Department cohort.
    Results: Derivation included 1246 patients, 156 (12.5%) had the primary outcome; validation included 1139 patients, 170 (14.9%) had the primary outcome. Derivation demonstrated Sn 25.6% (95% CI 19.0-33.2), Sp 96.3% (95% CI 95.0-97.4), PPV 50.0% (95% CI 40.0-60.0) and NPV 90.1% (95% CI 89.2-90.9). Validation demonstrated Sn 23.5% (95% CI 17.4% to 30.6%), Sp 95.2% (95% CI 93.6% to 96.4%), PPV 46.0% (95% CI 36.6% to 55.7%) and NPV 87.6% (95% CI 86.7% to 88.5%).
    Conclusion: We have derived and validated an ECG model that is highly specific for NSTEMI and may be suitable for integration into existing clinical decision aids.
    MeSH term(s) Acute Coronary Syndrome/diagnosis ; Electrocardiography ; Emergency Service, Hospital ; Humans ; Non-ST Elevated Myocardial Infarction/diagnosis ; Prospective Studies ; Reproducibility of Results ; Retrospective Studies
    Language English
    Publishing date 2022-04-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605890-5
    ISSN 1532-8171 ; 0735-6757
    ISSN (online) 1532-8171
    ISSN 0735-6757
    DOI 10.1016/j.ajem.2022.04.016
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    Zs.A 2005: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  9. Article ; Online: The Diagnostic Accuracy of the Emergency Department Assessment of Chest Pain (EDACS) Score: A Systematic Review and Meta-analysis.

    Boyle, Richard S J / Body, Richard

    Annals of emergency medicine

    2021  Volume 77, Issue 4, Page(s) 433–441

    Abstract: Study objective: We evaluate current evidence for the diagnostic accuracy and safety of the Emergency Department Assessment of Chest Pain Score (EDACS) for patients presenting to the emergency department (ED) with possible acute coronary syndromes.: ... ...

    Abstract Study objective: We evaluate current evidence for the diagnostic accuracy and safety of the Emergency Department Assessment of Chest Pain Score (EDACS) for patients presenting to the emergency department (ED) with possible acute coronary syndromes.
    Methods: MEDLINE, EMBASE, and Cochrane databases were searched for publications reporting data on the EDACS score. No date restrictions were used. Two independent researchers assessed studies for eligibility, bias, and quality. The primary outcome was major adverse cardiac events occurring within 30 days. Heterogeneity was assessed and data were pooled by meta-analysis using a random-effects model.
    Results: Eight diagnostic test accuracy studies including 11,578 patients and 1 randomized controlled trial including 558 patients were eligible for inclusion. On meta-analysis, the EDACS score had a pooled sensitivity of 96.1% (95% confidence interval 89.6% to 98.6%) and specificity of 61.1% (95% confidence interval 55.5% to 66.3%). A total of 55.0% of patients (n=6,370/11,578) were identified as low risk and eligible for early discharge. Sixty-two patients (0.54%) identified as low risk had an outcome of major adverse cardiac events within 30 days.
    Conclusion: The EDACS score identified greater than 50% of patients with suspected acute coronary syndrome as suitable for discharge after serial troponin sampling during 2 hours. Sensitivity for major adverse cardiac events was relatively high overall and may be acceptable to clinicians.
    MeSH term(s) Acute Coronary Syndrome/diagnosis ; Chest Pain/diagnosis ; Emergency Service, Hospital ; Humans ; Risk Assessment/methods
    Language English
    Publishing date 2021-01-16
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 603080-4
    ISSN 1097-6760 ; 0196-0644
    ISSN (online) 1097-6760
    ISSN 0196-0644
    DOI 10.1016/j.annemergmed.2020.10.020
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    Zs.A 1344: Show issues Location:
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  10. Article: Accuracy or efficiency? Striking the balance for your chest pain pathway

    Body, Richard

    Heart

    Abstract: Should you use the 1 hour algorithm, the High-Sensitivity Troponin in the Evaluation of patients with suspected Acute Coronary Syndrome (High-STEACS) algorithm or should you incorporate clinical features by adopting the HEART pathway or Emergency ... ...

    Abstract Should you use the 1 hour algorithm, the High-Sensitivity Troponin in the Evaluation of patients with suspected Acute Coronary Syndrome (High-STEACS) algorithm or should you incorporate clinical features by adopting the HEART pathway or Emergency Department Assessment of Chest Pain (EDACS) decision aid? In this issue, Stopyra et al 7 used real-world data to compare the accuracy of the HEART pathway and the EDACS decision aid for predicting major adverse cardiac events (MACEs) within 30 days (REF) What is an acceptable risk of major adverse cardiac event in chest pain patients soon after discharge from the emergency department?: a clinical survey
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #822879
    Database COVID19

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