Anxiety is Prevailing in Non-Cardiac Chest Pain Subjects, while Somatisation is Not A Comparative Study in the Emergency Department

Objective: The main purpose of this study was to verify if non-cardiac chest pain (NCCP) subjects recruited in an Emergency Department were more anxious, depressive or burdened by somatoform symptoms as compared with cardiac chest pain (CCP) subjects, and with subjects without chest pain (WOCP). Methods: We included patients with chest pain not attributable to a gastro-oesophageal reflux disorder. NCCP subjects were negative at ECG examination and at troponin test at baseline and after three months. A number of instruments were administered, measuring anxiety and depression (HADS), somatisation (somatisation scale of SCL- 90, TAS-20), and the health-related QoL (SF-12), along with other scales measuring the social and experiential profile. Results: We recruited 435 subjects (of which NCCP were 44.8%) in the Emergency Department, while other 147 subjects were recruited in a primary care clinic. The logistic regression showed that the levels of HADS anxiety in the three groups were dissimilar, even when adjusted for confounding variables: taking NCCP as reference category, adjusted ORs were 0.64 for CCP (IC95% 0.42 \u2013 0.96) and 0.23 for WOCP (IC95% 0.13 \u2013 0.40). When considering the somatisation construct, CCP and NCCP subjects reported similar somatic symptom complaints, higher than WOCP subjects. Moreover, even if NCCP subjects showed higher TAS-20 scores than WOCP subjects, these scores were below the range of a possible alexithymia. As for the physical health-related QoL (SF-12, subscale PCS-12), regression analyses showed that the PCS-12 mean score of NCCP was higher than that of CCP ( f -2.31; IC95% -4.14 to -0.48) and lower than that of WOCP ( f 2.24; IC95% 0.12 \u2013 4.37). Conclusion : NCCP subjects are characterised from an elevated anxiety, together with a better physical well-being, when compared with subjects who have a cardiac failure. The somatisation construct seems less useful to distinguish NCCP from CCP subjects. Consequently, anxiety should be the major target of our mental-health intervention when treating subjects with chest pain

A case-crossover study of alcohol consumption, meals and the risk of road traffic crashes

<p>Abstract</p> <p>Background</p> <p>The case-crossover (CC) design has proved effective to investigate the association between alcohol use and injuries in general, but has never been applied to study alcohol use and road traffic crashes (RTCs) specifically. This study aims at investigating the association between alcohol and meal consumption and the risk of RTCs using intrapersonal comparisons of subjects while driving.</p> <p>Methods</p> <p>Drivers admitted to an Italian emergency room (ER) after RTCs in 2007 were interviewed about personal, vehicle, and crash characteristics as well as hourly patterns of driving, and alcohol and food intake in the 24 hours before the crash. The odds ratio (OR) of a RTC was estimated through a CC, matched pair interval approach. Alcohol and meal consumption 6 and 2 hours before the RTC (case exposure window) were compared with exposures in earlier control windows of analogous length.</p> <p>Results</p> <p>Of 574 patients enrolled, 326 (56.8%) reported previous driving from 6 to 18 hours before the RTC and were eligible for analysis. The ORs (mutually adjusted) were 2.25 (95%CI 1.11-4.57) for alcohol and 0.94 (0.47-1.88) for meals. OR for alcohol was already increased at low (1-2 units) doses - 2.17 (1.03-4.57) and the trend of increase for each unit was significant - 1.64 (95%CI 1.05-2.57). In drivers at fault the OR for alcohol was 21.22 (2.31-194.79). The OR estimate for meal consumption seemed to increase in case of previous sleep deprivation, 2.06 (0.25-17.00).</p> <p>Conclusion</p> <p>Each single unit of acute alcohol consumption increases the risk of RTCs, in contrast with the 'legal' threshold allowed in some countries. Meal consumption is not associated with RTCs, but its combined effects with sleepiness need further elucidation.</p

A case of recurrent acute aortic syndrome: Beyond emergency diagnosis and treatment

Introduction: Acute aortic syndromes (AAS) are emergency conditions with a common pathway but various clinical manifestations. In order to reduce the extremely poor prognosis, these syndromes require a rapid diagnosis and decision making.Case report: We report the case of a young black woman with recurrent aortic dissection (RAD), presenting to the Emergency Department (ED) with an atypical symptom: ankle soreness. After the surgical treatment, several exams were performed in order to investigate underlying conditions for recurrence: after a first suspicion of tuberculous aortitis, the final diagnosis was Takayasu's arteritis.Discussion: The aim of this article is to underline the extremely heterogeneous presentation of AAS that worsens the already complicated process in diagnosing the syndromes. Despite uncommon signs and symptoms, identifying patients with a high pre-test likelihood for the disease is crucial to promptly get a correct diagnosis. Once the diagnosis has been confirmed, since AAS may be a spy for important systemic diseases, conditions such as congenital disease, autoimmune and infectious aortitis need to be excluded and treated to prevent any recurrence or systemic implications

Academy of Emergency Medicine and Care-Society of Clinical Biochemistry and Clinical Molecular Biology consensus recommendations for clinical use of sepsis biomarkers in the emergency department.

Increasing evidence is emerging that the measurement of circulating biomarkers may be clinically useful for diagnosing and monitoring sepsis. Eight members of AcEMC (Academy of Emergency Medicine and Care) and eight members of SIBioC (Italian Society of Clinical Biochemistry and Laboratory Medicine) were identified by the two scientific societies for producing a consensus document aimed to define practical recommendations about the use of biomarkers for diagnosing of sepsis and managing antibiotic therapy in the emergency department (ED). The cumulative opinions allowed defining three grade A recommendations (i.e., highly recommended indications), entailing ordering modality (biomarkers always available on prescription), practical use (results should be interpreted according to clinical information) and test ordering defined according to biomarker kinetics. Additional grade B recommendations (i.e., potentially valuable indications) entailed general agreement that biomarkers assessment may be of clinical value in the diagnostic approach of ED patients with suspected sepsis, suggestion for combined assessment of procalcitonin (PCT) and Creactive protein (CRP), free availability of the selected biomarker(s) on prescription, adoption of diagnostic threshold prioritizing high negative predictive value, preference for more analytically sensitive techniques, along with potential clinical usefulness of measuring PCT for monitoring antibiotic treatment, with serial testing defined according to biomarker kinetics. PCT and CRP were the two biomarkers that received the largest consensus as sepsis biomarkers (grade B recommendation), and a grade B recommendation was also reached for routine assessment of blood lactate. The assessment of biomarkers other than PCT and CRP was discouraged, with exception of presepsin for which substantial uncertainty in favor or against remained

Academy of Emergency Medicine and Care-Society of Clinical Biochemistry and Clinical Molecular Biology consensus recommendations for clinical use of sepsis biomarkers in the emergency department.

Increasing evidence is emerging that the measurement of circulating biomarkers may be clinically useful for diagnosing and monitoring sepsis. Eight members of AcEMC (Academy of Emergency Medicine and Care) and eight members of SIBioC (Italian Society of Clinical Biochemistry and Laboratory Medicine) were identified by the two scientific societies for producing a consensus document aimed to define practical recommendations about the use of biomarkers for diagnosing of sepsis and managing antibiotic therapy in the emergency department (ED). The cumulative opinions allowed defining three grade A recommendations (i.e., highly recommended indications), entailing ordering modality (biomarkers always available on prescription), practical use (results should be interpreted according to clinical information) and test ordering defined according to biomarker kinetics. Additional grade B recommendations (i.e., potentially valuable indications) entailed general agreement that biomarkers assessment may be of clinical value in the diagnostic approach of ED patients with suspected sepsis, suggestion for combined assessment of procalcitonin (PCT) and Creactive protein (CRP), free availability of the selected biomarker(s) on prescription, adoption of diagnostic threshold prioritizing high negative predictive value, preference for more analytically sensitive techniques, along with potential clinical usefulness of measuring PCT for monitoring antibiotic treatment, with serial testing defined according to biomarker kinetics. PCT and CRP were the two biomarkers that received the largest consensus as sepsis biomarkers (grade B recommendation), and a grade B recommendation was also reached for routine assessment of blood lactate. The assessment of biomarkers other than PCT and CRP was discouraged, with exception of presepsin for which substantial uncertainty in favor or against remained

The exclusion of acute venous thrombosis in ER: experience in Udine

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Reducing the risk of hospital admission: A call to action from the Italian Society of Internal Medicine

The belief that hospital stays may constitute per se a risk for patients is not widespread among patients and health care professionals. In the balance between advantages and disadvantages of admission, we rarely take into account the impact of the hospital stay itself on the well-being of the patient. In a society that is getting older the hospital may become a hostile environment for the complex and frail patient. Reducing the risks associated with hospital admission implies a radical cultural change accepted and shared by all health care professionals. The critical reconsideration of admission is a way of reasoning not only on hospitalisation but also on what the correct health outcome paradigms should be