![]() ![]() Links for help with getting through residency: No links or images linking to the NP or PA subs posted for targeted harassment. No targeted harassment against individuals or organizations.Ĩ. No personal agendas, spam, or links to websites for brigading.ħ. B) If you message the moderators about a removed post you must link the post in your message or will be ignoredĦ. A) New and anonymous accounts are welcome but posts and comments may be delayed as they must be approved manually.ĥ. No protected health information or personal information.ĥ. No questions about applying to residency or medical school. No questions pertaining to medical school. No "What are my chances?" or similar threads. If you have any suggestions to make the sub better, please message the moderator.Ģ. Welcome to the Residency subreddit, a community of interns and residents who are just trying to make it through! ![]() A larger, prospective study with narrower confidence intervals in a US population would be nice, but best current evidence is that the HEART score performs better than TIMI and GRACE scores.This is a sub dedicated to resident physicians in training.The Heart Score was developed in an ED setting in all patients with chest pain and not just ACS patients.The HEART score provides a quick and reliable predictor of outcomes in chest pain patients presenting to the ED. Confidence interval was a bit wide when looking at the total study population (i.e.No comparison of Heart Score to clinical gestalt.Each ED had different cut-off values for positive troponins.Study performed on patient population from the Netherlands.* Risk factors = DM, current or recent ( TIMI (0.75) > GRACE (0.70) In truth, clinical judgement plays a huge role for physicians in the ED when evaluating chest pain patients, so wouldn’t it make sense to have a risk score that follows this? Well, that is exactly what the HEART score does! What is the HEART Score (Original Study)? 2 The HEART Score for Chest Pain Patients in the ED c-statistic 0.70)Īll of the above scores are well validated, but none of them emphasizes patient history as part of the score, used in identification of ACS in the ED setting, and chest pain due to causes other than ACS were not evaluated in these trials. FRISC: Like TIMI, is simple to use but has a poor predictive power (i.e.Also patients not divided into different risk groups GRACE: Very complex to use and a large portion of the score is dependent on the patient age.TIMI: Simple to use, but has a poor predictive power (i.e.PURSUIT: Does not include troponin assays as part of score and the majority of the score is dependent on patient age. ![]() What is the applicability of each score to clinical practice in the ED? Prediction of combined endpoint of MI, PCI, CABG or death within 6 weeks after presentation Treatment effect of early invasive strategies in ACS Risk of hospital death and post-discharge seat at 6 months Risk of all cause mortality, MI, and severe recurrent ischemia requiring urgent revascularization within 14 days after admission Risk of Death or death/MI at 30 days after admission What are some of the scoring methods currently used? 1 Risk Score Currently, most guidelines and risk stratification scores focus on the identification of high risk ACS patients that would benefit from early aggressive therapies, but what about all the other chest pain patients that don’t have ACS… are they accounted for? Specifically, when dealing with ACS, dynamic ECG changes or positive cardiac biomarkers is pretty much a slam dunk admission in most cases, but a lack of these does not completely rule out ACS. The challenge in the ED is to not only to identify high risk patients but also to identify patients who can be safely discharged home. musculoskeletal pain, gastroesophageal reflux disease (GERD), pericarditis). acute coronary syndrome (ACS), pulmonary embolism, aortic dissection) and non-urgent diagnoses (i.e. Chest pain is a common presentation complaint to the emergency department (ED) and has a wide range of etiologies including urgent diagnoses (i.e. ![]()
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