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[http://www.freejournalsact.com/] List of Free / Open Access journals.

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[http://www.indexscholar.com/] An index contains more than 700.000 fulltext articles.

 

Emergency Medicine : Predictors of 30-Day Serious Events in Older Patients with Syncope

Study objective

We identify predictors of 30-day serious events after syncope in older adults.

Methods

We reviewed the medical records of older adults (age ≥60 years) who presented with syncope or near syncope to one of 3 emergency departments (EDs) between 2002 and 2005. Our primary outcome was occurrence of a predefined serious event within 30 days after ED evaluation. We used multivariable logistic regression to identify predictors of 30-day serious events.

Results

Of 3,727 potentially eligible patients, 2,871 (77%) met all eligibility criteria. We excluded an additional 287 patients who received a diagnosis of a serious clinical condition while in the ED. In the final study cohort (n=2,584), we identified 173 (7%) patients who experienced a 30-day serious event. High-risk predictors included age greater than 90 years, male sex, history of an arrhythmia, triage systolic blood pressure greater than 160 mm Hg, abnormal ECG result, and abnormal troponin I level. A low-risk predictor was a complaint of near syncope rather than syncope. A risk score, generated by summing high-risk predictors and subtracting the low-risk predictor, can stratify patients into low- (event rate 2.5%; 95% confidence interval [CI] 1.4% to 3.6%), intermediate- (event rate 6.3%; 95% CI 5.1% to 7.5%), and high-risk (event rate 20%; 95% CI 15% to 25%) groups.

Conclusion

We identified predictors of 30-day serious events after syncope in adults aged 60 years and greater. A simple score was able to stratify these patients into distinct risk groups and, if externally validated, might have the potential to aid ED decisionmaking.

Emergency Medicine: Introduction

Emergency Medicine : History

French military surgeon Domnique Jean Larry brought the idea of ambulances for rapid transport of wounded soldiers to a central place where effective medical care was accessible. But,as a medical speciality,Emergency Medicine Department is relatively new speciality. Before 60s and & 70s emergency care was provided by staffs from different specialities rotated through emergency service. During that period, the battle of Korea and Vietnam brought great incite in terms of resuscitation to victims of sudden death by lay persons. Mechanisation and fast growing population and their unscheduled demand for emergency medical care was rising all over in Western hemisphere, specifically USA and UK. There were urgent need for 24/7 medical care.

In USA, two different plan were enacted in late 60s 1) Pontiac, where some private practitioners had been working in emergency department on part time basis at Pontiac Genaral Hospital(MI) and, 2) Alexandria plan (VA), here another group of physicians left there private practice and became full time emergency physician. In 1968, American College of Emergency Physician was established and later in 197o first residency programme in EM was started at the University of Cincinnati. In 1976, ABEM was incorporated. Later, ABEM was included in American Board of Specialities and finally, in 1980 ABEM conducted first Board Certification Examination for EM.

In United Kingdom, history of modern emergency medicine speciality begins from 1952 when first full time casualty consultant was appointed. Since then, several name changed for casualty departmet, including accident and emergency medicine and finally emergency medicine in 2004. In 1972, Accident and Emergency medicine was recognised as an independent speciality and 30 consultant posts of A&E consultant were created. In 2008, College of Emergency medicine was established under royal charter.

In 1978, Canadian Association of Emergency Physician was established. In 1981, Astralian Society of Emergency Medicine was formed, while Australasian College of Emergency Medicine and European Society of Emergency Medicine came to exist in 1984 and 1994 respectively.