Diagnosing Dyspneic Older Adult Emergency Department Patients: A Pilot Study.
Diagnosing Dyspneic Older Adult Emergency Department Patients: A Pilot Study.
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诊断呼吸困难的老年成人急诊科患者：一项试点研究。
DOI：
10.1111/acem.14183
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发表时间：
2021-06
期刊：
影响因子：
--
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中科院分区：
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肺炎、慢性阻塞性肺疾病（COPD）和心力衰竭（HF）急性加重在急诊科（艾德）的老年人中可能存在类似情况，导致过度诊断和诊断不足导致次优治疗。抗菌肽（AMP）可能在提高这些患者肺炎的准确诊断中发挥作用。本初探性研究是一项前瞻性、观察性队列研究，研究对象为因呼吸困难或呼吸频率升高就诊于艾德的老年人（年龄≥65岁）。为了确定肺炎的生物标志物，比较了肺炎患者和非肺炎患者的白色血细胞计数、降钙素原（PCT）和抗菌肽（人β防御素1和2 [HBD-1，-2]、人中性粒细胞肽1-3 [HNP 1 -3]和凯萨林定[LL-37]）的血清水平。标准审查者回顾性地确定了ED中的诊断。筛选了391例患者，其中140例合格，79例入选。根据标准审查，10例患者（12.7%）存在肺炎，9例患者（11.4%）存在COPD，31例患者（39.2%）存在HF，根据标准审查，合并诊断率为10.1%。急诊科主治医师诊断肺炎16例（20.3%），COPD 12例（15.2%），HF 30例（38.0%），共诊断率为15.2%。90%的肺炎、75%的COPD和65%的HF诊断符合标准诊断。白细胞计数（p<0.01）和两种新型AMP（DEFA 5（p=0.08）和DEFB 2（p=0.09））的差异显示出诊断肺炎的前景。急诊医生对老年呼吸困难患者的诊断准确性仍然很差。血清AMP水平是提高这一重要人群诊断准确性和结局的一个潜在工具，需要进一步研究。
Pneumonia, chronic obstructive pulmonary disease (COPD), and heart failure (HF) exacerbations can present similarly in the older adult in the Emergency Department (ED), leading to sub-optimal treatment from over- and under-diagnosis. There may be a role for antimicrobial peptides (AMPs) in improving the accurate diagnosis of pneumonia in these patients. This pilot was a prospective, observational cohort study of older adults (aged ≥65 years of age) who presented to the ED with dyspnea or elevated respiratory rate. To identify biomarkers of pneumonia, serum levels of white blood cell count, procalcitonin (PCT), and antimicrobial peptides (human beta defensin 1 and 2 [HBD-1, -2], human neutrophil peptides 1–3 [HNP1–3] and cathelididin [LL-37]) were compared between those with and without pneumonia. Criterion standard reviewers retrospectively determined the diagnoses present in the ED. Three hundred ninety-one patients were screened, 140 were eligible, and 79 were enrolled. Based on criterion standard review, pneumonia was present in 10 (12.7%), COPD in 9 (11.4%) and HF in 31 (39.2%) with a co-diagnosis rate of 10.1% by criterion standard review. Comparatively, emergency medicine attending physicians diagnosed pneumonia in 16 (20.3%), COPD in 12 (15.2%), and HF in 30 (38.0%) with co-diagnosis rate of 15.2%. Emergency physicians agreed with criterion standard diagnoses in 90% of pneumonia, 75% of COPD and 65% of HF diagnoses. Differences in leukocyte count (p<0.01) and two novel AMPs (DEFA5 (p=0.08) and DEFB2 (p=0.09)) showed promise for diagnosing pneumonia. Emergency physicians continue to have poor diagnostic accuracy in dyspneic older adult patients. Serum AMP levels are one potential tool to improve diagnostic accuracy and outcomes for this important population and require further study.
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影响因子：
3.6
作者：
Chandra, Abhinav;Nicks, Bret;Limkakeng, Alexander
通讯作者：
Limkakeng, Alexander
影响因子：
6.7
作者：
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通讯作者：
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DOI：
10.1186/cc4926
发表时间：
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期刊：
Critical care (London, England)
影响因子：
--
作者：
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通讯作者：
Boddaert J
影响因子：
3.6
作者：
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通讯作者：
Geeraerts, Thomas
影响因子：
--
作者：
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通讯作者：
Januzzi, James L., Jr.