1
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Faksova K, Walsh D, Jiang Y, Griffin J, Phillips A, Gentile A, Kwong JC, Macartney K, Naus M, Grange Z, Escolano S, Sepulveda G, Shetty A, Pillsbury A, Sullivan C, Naveed Z, Janjua NZ, Giglio N, Perälä J, Nasreen S, Gidding H, Hovi P, Vo T, Cui F, Deng L, Cullen L, Artama M, Lu H, Clothier HJ, Batty K, Paynter J, Petousis-Harris H, Buttery J, Black S, Hviid A. COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals. Vaccine 2024; 42:2200-2211. [PMID: 38350768 DOI: 10.1016/j.vaccine.2024.01.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND The Global COVID Vaccine Safety (GCoVS) Project, established in 2021 under the multinational Global Vaccine Data Network™ (GVDN®), facilitates comprehensive assessment of vaccine safety. This study aimed to evaluate the risk of adverse events of special interest (AESI) following COVID-19 vaccination from 10 sites across eight countries. METHODS Using a common protocol, this observational cohort study compared observed with expected rates of 13 selected AESI across neurological, haematological, and cardiac outcomes. Expected rates were obtained by participating sites using pre-COVID-19 vaccination healthcare data stratified by age and sex. Observed rates were reported from the same healthcare datasets since COVID-19 vaccination program rollout. AESI occurring up to 42 days following vaccination with mRNA (BNT162b2 and mRNA-1273) and adenovirus-vector (ChAdOx1) vaccines were included in the primary analysis. Risks were assessed using observed versus expected (OE) ratios with 95 % confidence intervals. Prioritised potential safety signals were those with lower bound of the 95 % confidence interval (LBCI) greater than 1.5. RESULTS Participants included 99,068,901 vaccinated individuals. In total, 183,559,462 doses of BNT162b2, 36,178,442 doses of mRNA-1273, and 23,093,399 doses of ChAdOx1 were administered across participating sites in the study period. Risk periods following homologous vaccination schedules contributed 23,168,335 person-years of follow-up. OE ratios with LBCI > 1.5 were observed for Guillain-Barré syndrome (2.49, 95 % CI: 2.15, 2.87) and cerebral venous sinus thrombosis (3.23, 95 % CI: 2.51, 4.09) following the first dose of ChAdOx1 vaccine. Acute disseminated encephalomyelitis showed an OE ratio of 3.78 (95 % CI: 1.52, 7.78) following the first dose of mRNA-1273 vaccine. The OE ratios for myocarditis and pericarditis following BNT162b2, mRNA-1273, and ChAdOx1 were significantly increased with LBCIs > 1.5. CONCLUSION This multi-country analysis confirmed pre-established safety signals for myocarditis, pericarditis, Guillain-Barré syndrome, and cerebral venous sinus thrombosis. Other potential safety signals that require further investigation were identified.
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Affiliation(s)
- K Faksova
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
| | - D Walsh
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - Y Jiang
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - J Griffin
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - A Phillips
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - A Gentile
- Department of Epidemiology, Ricardo Gutierrez Children Hospital, Buenos Aires University, Argentina
| | - J C Kwong
- ICES, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - K Macartney
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia; The University of Sydney, Australia
| | - M Naus
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Z Grange
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - S Escolano
- Université Paris-Saclay, UVSQ, Inserm, CESP, High Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, France
| | - G Sepulveda
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - A Shetty
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - A Pillsbury
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - C Sullivan
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - Z Naveed
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - N Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - N Giglio
- Department of Epidemiology, Ricardo Gutierrez Children Hospital, Buenos Aires University, Argentina
| | - J Perälä
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - S Nasreen
- ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - H Gidding
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia; The University of Sydney, Australia
| | - P Hovi
- Department of Public Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - T Vo
- Faculty of Social Sciences, Tampere University, Finland
| | - F Cui
- School of Public Health, Peking University, China
| | - L Deng
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - L Cullen
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - M Artama
- Faculty of Social Sciences, Tampere University, Finland
| | - H Lu
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - H J Clothier
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - K Batty
- Auckland UniServices Limited at University of Auckland, New Zealand
| | - J Paynter
- School of Population Health, University of Auckland, New Zealand
| | - H Petousis-Harris
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; School of Population Health, University of Auckland, New Zealand
| | - J Buttery
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; Murdoch Children's Research Institute, Parkville, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia
| | - S Black
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; School of Population Health, University of Auckland, New Zealand
| | - A Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Phillips A, Jiang Y, Walsh D, Andrews N, Artama M, Clothier H, Cullen L, Deng L, Escolano S, Gentile A, Gidding G, Giglio N, Junker T, Huang W, Janjua N, Kwong J, Li J, Nasreen S, Naus M, Naveed Z, Pillsbury A, Stowe J, Vo T, Buttery J, Petousis-Harris H, Black S, Hviid A. Background rates of adverse events of special interest for COVID-19 vaccines: A multinational Global Vaccine Data Network (GVDN) analysis. Vaccine 2023; 41:6227-6238. [PMID: 37673715 DOI: 10.1016/j.vaccine.2023.08.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The Global COVID Vaccine Safety (GCoVS) project was established in 2021 under the multinational Global Vaccine Data Network (GVDN) consortium to facilitate the rapid assessment of the safety of newly introduced vaccines. This study analyzed data from GVDN member sites on the background incidence rates of conditions designated as adverse events of special interest (AESI) for COVID-19 vaccine safety monitoring. METHODS Eleven GVDN global sites obtained data from national or regional healthcare databases using standardized methods. Incident events of 13 pre-defined AESI were included for a pre-pandemic period (2015-19) and the first pandemic year (2020). Background incidence rates (IR) and 95% confidence intervals (CI) were calculated for inpatient and emergency department encounters, stratified by age and sex, and compared between pre-pandemic and pandemic periods using incidence rate ratios. RESULTS An estimated 197 million people contributed 1,189,652,926 person-years of follow-up time. Among inpatients in the pre-pandemic period (2015-19), generalized seizures were the most common neurological AESI (IR ranged from 22.15 [95% CI 19.01-25.65] to 278.82 [278.20-279.44] per 100,000 person-years); acute disseminated encephalomyelitis was the least common (<0.5 per 100,000 person-years at most sites). Pulmonary embolism was the most common thrombotic event (IR 45.34 [95% CI 44.85-45.84] to 93.77 [95% CI 93.46-94.08] per 100,000 person-years). The IR of myocarditis ranged from 1.60 [(95% CI 1.45-1.76) to 7.76 (95% CI 7.46-8.08) per 100,000 person-years. The IR of several AESI varied by site, healthcare setting, age and sex. The IR of some AESI were notably different in 2020 compared to 2015-19. CONCLUSION Background incidence of AESIs exhibited some variability across study sites and between pre-pandemic and pandemic periods. These findings will contribute to global vaccine safety surveillance and research.
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Affiliation(s)
- A Phillips
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Y Jiang
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - D Walsh
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - N Andrews
- UK Health Security Agency, London, UK
| | - M Artama
- Faculty of Social Sciences, Tampere University, Finland
| | - H Clothier
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - L Cullen
- Public Health Scotland, Edinburgh, Scotland, UK
| | - L Deng
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - S Escolano
- Université Paris-Saclay, UVSQ, Inserm, CESP, High Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, France
| | - A Gentile
- Hospital de Niños Ricardo Gutierrez Epidemiology Department Buenos Aires City, Argentina
| | - G Gidding
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia; The University of Sydney Northern Clinical School, Australia
| | - N Giglio
- Hospital de Niños Ricardo Gutierrez Epidemiology Department Buenos Aires City, Argentina
| | - T Junker
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - W Huang
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan; National Taiwan University Children's Hospital, Taipei, Taiwan
| | - N Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada
| | - J Kwong
- ICES, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - J Li
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - S Nasreen
- ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - M Naus
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Z Naveed
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - A Pillsbury
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - J Stowe
- UK Health Security Agency, London, UK
| | - T Vo
- Faculty of Social Sciences, Tampere University, Finland; Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - J Buttery
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - H Petousis-Harris
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; Associate Professor, School of Population Health, University of Auckland, New Zealand
| | - S Black
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - A Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Doudesis D, Lee KK, Bularga A, Ferry AV, Tuck C, Anand A, Boeddinghaus J, Mueller C, Greenslade JH, Pickering JW, Than MP, Cullen L, Mills NL. Machine learning to optimise use of cardiac troponin in the diagnosis of acute myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Guidelines recommend fixed cardiac troponin thresholds for the assessment of patients with suspected acute coronary syndrome, however, performance varies in important patient groups as concentrations are influenced by age, sex and comorbidities. This limitation can be addressed using machine learning algorithms.
Methods
Machine learning algorithms were developed that integrate cardiac troponin concentrations at presentation or on serial testing with age, sex and clinical features in 10,038 consecutive emergency patients with suspected acute coronary syndrome. The primary outcome was an adjudicated diagnosis of type 1, type 4b or type 4c myocardial infarction. The best performing algorithm was selected for the CoDE-ACS (Collaboration for the Diagnosis and Evaluation of Acute Coronary Syndrome) decision-support tool, and performance was externally validated in 3,035 patients pooled from three prospective studies.
Findings
CoDE-ACS had excellent discrimination and calibration using cardiac troponin at presentation (area under curve [AUC] 0.959, 95% confidence interval 0.948–0.971, Brier score 0.040), in the pooled external validation cohort. At presentation, the rule-out score identified 62.1% (1,885/3,035) of all patients as low-probability of myocardial infarction with a 99.5% (99.1–99.7%) negative predictive value and 97.0% (96.3–97.6%) sensitivity. The rule-in score identified 8.3% (252/3,035) of patients as high-probability with an 83.7% (82.4–85.0%) positive predictive value and 98.5% (98.0–98.9%) specificity. Performance of the rule-out and rule-in scores was consistent across patient subgroups (Figure 1 and Figure 2). CoDE-ACS incorporating a second cardiac troponin measurement also had excellent discrimination and calibration (AUC 0.971 [0.962–0.980], Brier score 0.039) and refined the individualised probabilities in the 29.5% (898/3,035) of patients neither ruled-out or ruled-in at presentation to guide further investigation.
Conclusions
We developed and externally validated the CoDE-ACS decision-support tool using machine learning to aid in the diagnosis of myocardial infarction. CoDE-ACS had excellent diagnostic performance to rule-out and rule-in myocardial infarction at presentation, performed consistently across patient subgroups, and provided individualised probabilities to guide further care in those who require serial troponin measurements.
Conclusions
We developed and externally validated the CoDE-ACS decision-support tool using machine learning to aid in the diagnosis of myocardial infarction. CoDE-ACS had excellent diagnostic performance to rule-out and rule-in myocardial infarction at presentation, performed consistently across patient subgroups, and provided individualised probabilities to guide further care in those who require serial troponin measurements.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health ResearchBritish Heart Foundation
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Affiliation(s)
- D Doudesis
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - K K Lee
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - A Bularga
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - A V Ferry
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - C Tuck
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - A Anand
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - J Boeddinghaus
- University of Basel, Cardiovascular Research Institute Basel and Department of Cardiology , Basel , Switzerland
| | - C Mueller
- University of Basel, Cardiovascular Research Institute Basel and Department of Cardiology , Basel , Switzerland
| | - J H Greenslade
- University of Queensland, School of Medicine , Brisbane , Australia
| | - J W Pickering
- University of Otago, Christchurch Heart Institute , Christchurch , New Zealand
| | - M P Than
- Christchurch Hospital , Christchurch , New Zealand
| | - L Cullen
- University of Queensland, School of Medicine , Brisbane , Australia
| | - N L Mills
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
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4
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Akpalu A, Sykes L, Nkromah K, Attoh J, Osei-Yeboah C, Johnson L, Amponsah C, Laryea F, Anarfi O, Shaw A, Cullen L, Easton S, Fullbrook-Scanlon C, Gordon C, Spice C. Experiences of Multidisciplinary Working: Perspectives from the Wessex Ghana Stroke Partnership. West Afr J Med 2022; 39:641-645. [PMID: 35752973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Substantial gaps remain in our understanding of stroke in Africa as well as in stroke care, practice and policy on the continent. The effective organization of preventative, therapeutic and rehabilitative stroke services continue to be challenging in many African countries. METHODOLOGY In this article we define the nature, function and benefits of effective multidisciplinary team (MDT) working. The experiences and perspectives of members of the MDT were collated by focus group discussions as well as individual and country specific contributions. RESULTS The experiences and perspectives of multidisciplinary team members from the United Kingdom and Ghana implementing these practices at the first stroke unit in Korle Bu Teaching Hospital, Accra, with a transparent discussion of successes and challenges faced throughout development of the service, is presented. MDT working has improved outcomes for patients and families who use the services, including encouraging better shared treatment planning and compliance. More stroke rehabilitation services are provided than previously, including greater self-management education and better secondary prevention care. CONCLUSION It is hoped that this article will provide an inspirational model for others working to provide stroke care in low-resource settings in Africa and worldwide.
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Affiliation(s)
- A Akpalu
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Ghana
- Stroke Unit, Korle Bu Teaching Hospital, Ghana
| | - L Sykes
- Hampshire Hospitals NHS Trust, Royal Hampshire County Hospital, Winchester, UK
| | - K Nkromah
- Stroke Unit, Korle Bu Teaching Hospital, Ghana
| | - J Attoh
- Stroke Unit, Korle Bu Teaching Hospital, Ghana
| | | | - L Johnson
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - C Amponsah
- Stroke Unit, Korle Bu Teaching Hospital, Ghana
- University of Ghana School of Biomedical and Allied Health Sciences, Department of Speech and Language Therapy, Ghana
| | - F Laryea
- Stroke Unit, Korle Bu Teaching Hospital, Ghana
| | - O Anarfi
- Stroke Unit, Korle Bu Teaching Hospital, Ghana
- University of Health and Allied Sciences School of Medicine, Department of Psychological Medicine and Mental Health, Ghana
| | - A Shaw
- University of Winchester, Winchester, UK
| | - L Cullen
- NHS England Southeast, Southampton, UK
| | - S Easton
- Hampshire Hospitals NHS Trust, Royal Hampshire County Hospital, Winchester, UK
| | | | - C Gordon
- University of Central Lancashire, Faculty of Health and Social Care, Preston, UK
| | - C Spice
- Queen Alexandra Hospital, Southwick Hill, Portsmouth, UK
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Khan E, Lambrakis K, Briffa T, Cullen L, Karnon J, Papendick C, Quinn S, Tideman P, Van Den Hengel A, Verjans J, Chew D. Re-Engineering the Clinical Approach to Suspected Cardiac Chest Pain Assessment in the Emergency Department by Expediting Research Evidence to Practice Using Artificial Intelligence (RAPIDx AI) – A Cluster Randomised Clinical Trial Design. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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6
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du Fay de Lavallaz J, Badertscher P, Zimmermann T, Nestelberger T, Walter J, Strebel I, Coelho C, Miró Ò, Salgado E, Christ M, Geigy N, Cullen L, Than M, Javier Martin-Sanchez F, Di Somma S, Frank Peacock W, Morawiec B, Wussler D, Keller DI, Gualandro D, Michou E, Kühne M, Lohrmann J, Reichlin T, Mueller C. Early standardized clinical judgement for syncope diagnosis in the emergency department. J Intern Med 2021; 290:728-739. [PMID: 33755279 DOI: 10.1111/joim.13269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/16/2020] [Accepted: 01/08/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The diagnosis of cardiac syncope remains a challenge in the emergency department (ED). OBJECTIVE Assessing the diagnostic accuracy of the early standardized clinical judgement (ESCJ) including a standardized syncope-specific case report form (CRF) in comparison with a recommended multivariable diagnostic score. METHODS In a prospective international observational multicentre study, diagnostic accuracy for cardiac syncope of ESCJ by the ED physician amongst patients ≥ 40 years presenting with syncope to the ED was directly compared with that of the Evaluation of Guidelines in Syncope Study (EGSYS) diagnostic score. Cardiac syncope was centrally adjudicated independently of the ESCJ or conducted workup by two ED specialists based on all information available up to 1-year follow-up. Secondary aims included direct comparison with high-sensitivity cardiac troponin I (hs-cTnI) and B-type natriuretic peptide (BNP) concentrations and a Lasso regression to identify variables contributing most to ESCJ. RESULTS Cardiac syncope was adjudicated in 252/1494 patients (15.2%). The diagnostic accuracy of ESCJ for cardiac syncope as quantified by the area under the curve (AUC) was 0.87 (95% CI: 0.84-0.89), and higher compared with the EGSYS diagnostic score (0.73 (95% CI: 0.70-0.76)), hs-cTnI (0.77 (95% CI: 0.73-0.80)) and BNP (0.77 (95% CI: 0.74-0.80)), all P < 0.001. Both biomarkers (alone or in combination) on top of the ESCJ significantly improved diagnostic accuracy. CONCLUSION ESCJ including a standardized syncope-specific CRF has very high diagnostic accuracy and outperforms the EGSYS score, hs-cTnI and BNP.
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Affiliation(s)
- J du Fay de Lavallaz
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - P Badertscher
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Department of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - T Zimmermann
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - T Nestelberger
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - J Walter
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - I Strebel
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - C Coelho
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - Ò Miró
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Hospital Clinic, Barcelona, Catalonia, Spain
| | - E Salgado
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Hospital Clinic, Barcelona, Catalonia, Spain
| | - M Christ
- Department of Emergency Medicine, Kantonsspital, Luzern, Switzerland
| | - N Geigy
- Department of Emergency Medicine, Hospital of Liestal, Liestal, Switzerland
| | - L Cullen
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Royal Brisbane & Women's Hospital, Herston, Australia
| | - M Than
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Christchurch Hospital, Christchurch, New Zealand
| | - F Javier Martin-Sanchez
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain
| | - S Di Somma
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Rome, Italy
| | - W Frank Peacock
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - B Morawiec
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - D Wussler
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - D I Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - D Gualandro
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - E Michou
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - M Kühne
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - J Lohrmann
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - T Reichlin
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Cardiology, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - C Mueller
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
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- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
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7
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Ratmann P, Nestelberger T, Cullen L, Lindahl B, Boeddinghaus J, Rubini M, Lopez Ayala P, Than M, Greenslade J, Mueller C. Utility of echocardiography in patients with suspected acute myocardial infarction in the presence of left bundle-branch block. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Rapid identification of acute myocardial infarction (AMI) as life-threatening disorder by clinical assessment, cardiac troponin and the electrocardiogram (ECG) is important for the early initiation of highly effective, evidence-based therapy. Patients presenting with suspected AMI and left bundle branch block (LBBB) to the emergency department (ED) represent a unique diagnostic and therapeutic challenge, as altered ventricular depolarization masks changes in ventricular repolarization associated with myocardial ischemia. Current guidelines suggest, based on expert opinion, early echocardiography as a helpful tool in patients with suspected AMI and LBBB to identify new wall motion abnormalities, which guides further diagnostics strategies in these patients.
Purpose
To evaluate the diagnostic accuracy of echocardiography among patients with suspected AMI and LBBB in the recorded ECG at ED presentation.
Methods
We prospectively evaluated the diagnostic accuracy of echocardiography in patients with LBBB presenting with chest discomfort to 26 ED's in three international, prospective, diagnostic studies. Two independent cardiologists centrally adjudicated the final diagnosis in each study according to the universal definition of myocardial infarction. All patients underwent a clinical assessment that included standardized and detailed medical history including assessment of chest pain characteristics, vital signs, physical examination, 12-lead ECG, continuous ECG rhythm monitoring, pulse oximetry, standard blood test, and chest radiography and echocardiography if indicated. We compared echocardiographic findings in patients with LBBB who were diagnosed with an AMI to those without an AMI.
Results
Among 283 patients presenting with chest pain and LBBB to the ED, AMI was the final diagnosis in 36% (102 of 283 patients) of patients. An echocardiography had been performed in 100/283 patients (35%) in the emergency department. AMI was the final diagnosis in 41/100 (41%) of patients. A wall motion abnormality in any region was seen in 77 (77%) of patients with no difference between patients diagnosed with AMI (33 patients, 81%) versus without AMI (44 patients, 75%, p=0.49). Additionally, we found no differences for each wall region (Table 1). Most patients with LBBB had moderately reduced left ventricular ejection fraction (LVEF, median 40%), a dilated left atrium (67%) or left ventricular hypertrophy (55%) without any differences between the two groups (Table 1).
Conclusions
Early echocardiography in patients with suspected AMI and LBBB provided only limited utility to identify patients, which may benefit from immediate coronary angiography. Our findings scrutinize current guidelines and downgrades the utility of echocardiography in this setting.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Swiss National Science Foundation, the Swiss Heart Foundation, the European Union, the Cardiovascular Research Foundation Basel, the University Hospital Basel, Queensland Emergency Medicine Research Foundation, Christchurch Heart Institute and Health Research Council and Heart Foundation of New Zealand, Christchurch Emergency Care Foundation
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Affiliation(s)
- P.D Ratmann
- University Hospital Basel, Basel, Switzerland
| | | | - L Cullen
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - B Lindahl
- Uppsala University Hospital, Uppsala, Sweden
| | | | - M Rubini
- University Hospital Basel, Basel, Switzerland
| | | | - M Than
- Christchurch Hospital, Christchurch, New Zealand
| | - J Greenslade
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
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8
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McCormack L, Milburn T, Ashover S, Berndt S, Foran L, Cullen L. 438 Accelerating the Care of Patients Presenting to Queensland Health EDs with Suspected ACS. Timely Translation of Advances in Care. – The Statewide ACRE II Project. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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9
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Wilkinson S, Greenslade J, Cullen L. 576 What is an Acceptable Risk of a Major Adverse Cardiac Event in Chest Pain Patients Soon After Discharge From the Emergency Department: The Patient’s Perspective. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Nestelberger T, Cullen L, Lindahl B, Reichlin T, Greenslade J, Giannitsis E, Morawiec B, Koechlin L, Twerenbold R, Boeddinghaus J, Rubini M, Osswald S, Pickering J, Than M, Mueller C. P2723Diagnosis of acute myocardial infarction in the presence of left bundle-branch block. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objective
Patients with suspected acute myocardial infarction (AMI) in the setting of left bundle branch block (LBBB) present an important diagnostic and therapeutic challenge to the clinician.
Methods
We prospectively evaluated incidence of AMI, and diagnostic performance of specific electrocardiographic (ECG) and high-sensitivity cardiac troponin (hs-cTn) criteria in patients presenting with chest discomfort to 26 emergency departments in three international, prospective, diagnostic studies. Presence of LBBB, ECG criteria, and final diagnoses were centrally adjudicated by two independent cardiologists using the fourth universal definition of myocardial infarction.
Results
Among 8830 patients, LBBB was present in 247 patients (2.8%). AMI was the final diagnosis in 30% of patients with LBBB, with similar incidence in those with known LBBB versus those with presumably new LBBB (29% vs 35%, p=0.42). ECG criteria had low sensitivity (1–12%), but high specificity (95–100%). The diagnostic accuracy as quantified by the receiver-operating-characteristics curve of hs-cTnT and hs-cTnI concentrations at presentation (AUC 0.91; 95% CI 0.85–0.96 and 0.89; 95% CI 0.83–0.95) as well as that of their 0/1h and 0/2h changes was very high. A diagnostic algorithm (Figure 1) combining ECG criteria with hs-cTnT/I concentrations and their absolute changes at 1h or 2h derived in cohort 1 (45 of 45 (100%) of patients with AMI correctly identified), showed high efficacy and accuracy when externally validated in cohort 2 & 3 (28 of 29 patients, 97%).
Figure 1
Conclusion
Most patients presenting with suspected AMI and LBBB will be found to have diagnoses other than AMI. Combining ECG criteria with Hs-cTn testing at 0/1h or 0/2h allows early and accurate diagnosis of AMI in LBBB.
Acknowledgement/Funding
European Union, Swiss National Foundation, University Hospital Basel, University Basel
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Affiliation(s)
- T Nestelberger
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - L Cullen
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - B Lindahl
- Uppsala University Hospital, Uppsala, Sweden
| | - T Reichlin
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - J Greenslade
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - E Giannitsis
- University Hospital of Heidelberg, Heidelberg, Germany
| | - B Morawiec
- Silesian Center for Heart Diseases (SCHD), Zabrze, Poland
| | - L Koechlin
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - R Twerenbold
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - J Boeddinghaus
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - M Rubini
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - J Pickering
- Christchurch Hospital, Christchurch, New Zealand
| | - M Than
- Christchurch Hospital, Christchurch, New Zealand
| | - C Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
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Aldous S, Pickering J, Young J, George P, Watson A, Troughton R, Pemberton C, Richards M, Cullen L, Than M. P2674Rapid rule-out of myocardial infarction with a novel high precision point-of-care troponin assay appears safe and effective. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
High sensitivity troponin assays were developed to improve analytical sensitivity and precision at the decision cut-points for the diagnosis and rule out of acute myocardial infarction (AMI). Central laboratory assays have achieved this but point of care assays, which have the ability to accelerate decision making due to much shorter turnaround times, have remained lacking.
Purpose
To ascertain the threshold for decision making and subsequent clinical utility for ruling out AMI on presentation in patients attending the emergency department acutely with chest pain, using a high precision point of care troponin assay (TnI Nx), (i-STAT, Abbott).
Methods
We measured arrival TnI-Nx concentrations in stored plasma samples in adults presenting acutely to the emergency department with chest pain. The primary outcome was an AMI or cardiac death on index admission or within 30 days. We used 2000 bootstrapped data sets to derive and validate a suitable threshold for TnI-Nx before calculating diagnostic test performance. We pre-specified this threshold must have a <1% false negative rate for the primary outcome. We compared this with a core laboratory high sensitivity troponin I (hs-TnI) (Abbott Architect) using the early rule-out cut-point (European Society of Cardiology) at the limit of detection (2 ng/L).
Results
We recruited 1320 patients of whom 192 (14.1%) had the primary outcome. The TnI-Nx threshold was determined to be 8 ng/L with subsequent sensitivity of 99.0% (95% confidence interval: 97.3% to 100%), negative predictive value of 99.7% (99.2% to 100%) and specificity of 59.0% (56.0% to 62.0%). The hs-TnI had a sensitivity of 99.5% (98.2% to 100%), negative predictive value of 99.7% (99.0% to 100%), and specificity of 28.4% (25.8% to 31.2%) at 2ng/L.
Conclusion
A high precision point of care assay, TnI-Nx, with a decision threshold of 8ng/L, has comparable rule out performance compared with a core laboratory high sensitivity assay and therefore could potentially be used for early decision making in the assessment of acute chest pain.
Acknowledgement/Funding
Research grant from Abbott Point of Care. Senior Research Fellowship from ECF, CMRF and CDHB. Clinical Research Fellowship from NZ HRC
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Affiliation(s)
- S Aldous
- Christchurch Hospital, Christchurch, New Zealand
| | - J Pickering
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - J Young
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - P George
- Christchurch Hospital, Christchurch, New Zealand
| | - A Watson
- Christchurch Hospital, Christchurch, New Zealand
| | - R Troughton
- Christchurch Hospital, Christchurch, New Zealand
| | - C Pemberton
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - M Richards
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - L Cullen
- Royal Brisbane and Women's Hospital, Emergency Department, Brisbane, Australia
| | - M Than
- Christchurch Hospital, Christchurch, New Zealand
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Nestelberger T, Boeddinghaus J, Greenslade J, Cullen L, Parsonage W, Troester V, Koechlin L, Rubini M, Badertscher P, Puelacher C, Twerenbold R, Mueller C. P1735Two-hour algorithm for early diagnosis of acute myocardial infarction using a novel high-sensitivity cardiac troponin I assay. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
We aimed to derive and externally validate a 0/2h-algorithm using the novel high-sensitivity cardiac troponin I (hs-cTnI-Access) assay.
Methods
We enrolled patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction (AMI) in two prospective chest pain trials. Two independent cardiologists adjudicated the final diagnosis including all available medical information including cardiac imaging. Hs-cTnI concentrations were measured at presentation and after 2h. Primary diagnostic endpoint was the derivation and validation of an hs-cTnI-Access specific 0/2h-algorithm. Primary prognostic endpoint was overall survival of patients after 30- and 720-days of follow-up.
Results
AMI was the adjudicated final diagnosis in 164/1131 (14.5%) patients in the derivation and in 88/1280 (6.9%) patients in the validation cohort. Median hs-cTnI Access concentrations at presentation were significantly higher in patients with AMI as compared to patients with non-AMI in both cohorts (104 ng/L versus 3.4 ng/L and 29 ng/L vs. 2.3 ng/L, p-value both <0.001) Applying the derived hs-cTnI-Access 0/2h-algorithm (Figure 1A) to the validation cohort (Figure 1B), 77.9% of patients were ruled-out (sensitivity 97.7% [95% CI, 92–99.7], negative predictive value [NPV] 99.8% [95% CI, 99.3–100]), and 5.8% of patients were ruled-in (specificity 98.6% [95% CI, 97.7–99.2], positive predictive value [PPV] 77% [95% CI, 65.8–86]). Among 1617 patients ruled-out for AMI in both cohorts together, 3 (0.2%) patients with AMI have been missed, of whom 2 patients had type 2 myocardial infarction (both with tachyarrhythmia). Patients ruled-out by the 0/2h-algorithm had a survival rate of 98.4% and 99.9% after two years or one year of follow up in both cohorts, respectively.
Figure 1
Conclusions
Diagnostic performance of the hs-cTnI Access 0/2h-algorithm for triage of AMI is excellent with high safety for rule-out and high accuracy for rule-in.
Acknowledgement/Funding
European Union, Swiss National Foundation, University Hospital Basel, University Basel
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Affiliation(s)
- T Nestelberger
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - J Boeddinghaus
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - J Greenslade
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - L Cullen
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - W Parsonage
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - V Troester
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - L Koechlin
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - M Rubini
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - P Badertscher
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - C Puelacher
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - R Twerenbold
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - C Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
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Hoe LS, Shuker T, Bartnikowski N, Passmore M, Bouquet M, Obonyo N, Engkilde-Pedersen S, McDonald C, Wells M, Boon A, Hyslop K, James L, Wildi K, Cullen L, Bassi GL, Suen J, McGiffin D, Fraser J. Characterisation of Cardiac Neurohormonal and Inflammatory Changes Induced by Brain Death in a Novel Ovine Heart Transplant Model. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Du Fay De Lavallaz J, Badertscher P, Nestelberger T, Miro O, Twerenbold R, Cullen L, Than M, Martin-Sanchez FJ, Keller D, Kuehne M, Reichlin T, Mueller C. P4836Sex-specific symptoms in the early diagnosis of syncope. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - P Badertscher
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - T Nestelberger
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - O Miro
- Hospital Clinic de Barcelona, Emergency Department, Barcelona, Spain
| | - R Twerenbold
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - L Cullen
- Royal Brisbane and Women's Hospital, Cardiology, Brisbane, Australia
| | - M Than
- Christchurch Hospital, Cardiology, Christchurch, New Zealand
| | | | - D Keller
- University Hospital Zurich, Emergency Department, Zurich, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - T Reichlin
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C Mueller
- University Hospital Basel, Cardiology, Basel, Switzerland
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15
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Khan E, Chuang A, Halabi A, Tiver K, Horsfall M, Briffa T, Sun B, Cullen L, French J, Chew D. P2713Impact of routine implementation of high sensitivity troponin in a state-wide health service. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E Khan
- Flinders Medical Centre and Flinders University, Cardiology, Adelaide, Australia
| | - A Chuang
- Flinders Medical Centre and Flinders University, Cardiology, Adelaide, Australia
| | - A Halabi
- Flinders Medical Centre and Flinders University, Cardiology, Adelaide, Australia
| | - K Tiver
- Flinders Medical Centre and Flinders University, Cardiology, Adelaide, Australia
| | - M Horsfall
- Flinders Medical Centre and Flinders University, Cardiology, Adelaide, Australia
| | - T Briffa
- The University of Western Australia, Perth, Australia
| | - B Sun
- Oregon Health & Science University, Portland, United States of America
| | - L Cullen
- University of Queensland, Brisbane, Australia
| | - J French
- Liverpool Hospital, Sydney, Australia
| | - D Chew
- Flinders Medical Centre and Flinders University, Cardiology, Adelaide, Australia
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16
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McCormack L, Cullen L, Graves N, Parsonage W, Starmer G, Stone R, Bonnin R, Starmer K, Drahm-Butler T, Davis T, Mowatt E, Proctor K, Campbell V, Greenslade J, Ashover S, Milburn T, Foran L. Validation of an Accelerated Diagnostic Protocol for Aboriginal and Torres Strait Islander Patients with Suspected Acute Coronary Syndrome. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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17
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See Hoe L, Obonyo N, Byrne L, Shiino K, Diab S, Dunster K, Passmore M, Boon C, Engkilde-Pedersen S, Esguerra A, Fauzi M, Pretti Pimenta L, Simonova G, Van Haren F, Shekar K, Anstey C, Tung J, Cullen L, Platts D, Chan J, Maitland K, Fraser J. Fluid Resuscitation with 0.9% Saline Impairs Myocardial Contractility in an Ovine Model of Endotoxaemic Shock. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Ruane L, Malhotra G, Greenslade J, Parsonage W, Cullen L. Sex Differences in Coronary Artery Anatomy in Chest Pain Patients Investigated With Coronary Angiography. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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19
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McCormack L, Ashover S, Milburn T, Foran L, Cullen L. Translating Chest Pain Research into Practice Through the Queensland Health ACRE Project - The Impact of Improved Assessment of Chest Pain Trial. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Rubini Gimenez M, Cullen L, Than M, Greenslade J, Twerenbold R, Boeddinghaus J, Nestelberger T, Wildi K, Badertscher P, Pickering J, Mueller C. P4685Diagnostic accuracy of cardiovascular risk factors for an acute coronary syndrome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Du Fay De Lavallaz J, Badertscher P, Nestelberger T, Cullen L, Than M, Miro O, Martin-Sanchez J, Morawiec B, Christ M, Di Somma S, Peacock F, Reichlin T, Osswald S, Mueller C. P82824-hour patterning of different syncope etiologies in patients presenting to the emergency department. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Nestelberger T, Cullen L, Lindahl B, Reichlin T, Greenslade J, Giannitsis E, Christ M, Morawiec B, Miro O, Martin-Sanchez J, Boeddinghaus J, Badertscher B, Du Fay De Lavallaz J, Puelacher C, Mueller C. P5585Diagnosis of acute myocardial infarction in patients presenting with left bundle branch block. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T. Nestelberger
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - L. Cullen
- Royal Brisbane and Women's Hospital, Emergency medicine, Brisbane, Australia
| | - B. Lindahl
- Uppsala Clinical Research Center, Medical Sciences, Uppsala, Sweden
| | - T. Reichlin
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - J. Greenslade
- Royal Brisbane and Women's Hospital, Emergency medicine, Brisbane, Australia
| | - E. Giannitsis
- University of Heidelberg, Medizinische Klinik III, Heidelberg, Germany
| | - M. Christ
- Lucerne Cantonal Hospital, Emergency medicine, Lucerne, Switzerland
| | - B. Morawiec
- Specialist Hospital in Zabrze, 2nd Cardiology department, Zabrze, Poland
| | - O. Miro
- Hospital Clinic de Barcelona, Emergency medicine, Barcelona, Spain
| | | | - J. Boeddinghaus
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - B. Badertscher
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - J. Du Fay De Lavallaz
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - C. Puelacher
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - C. Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
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23
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Badertscher P, Nestelberger T, Du Fay De Lavallaz J, Than M, Cullen L, Miro O, Martin-Sanchez F, Morawiec B, Christ M, Di Somma S, Peacock F, Osswald S, Reichlin T, Mueller C. P468Natural history of syncope: insights from the BASEL IX study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Badertscher P, Nestelberg T, Du Fay De Lavallaz J, Than M, Morawiec B, Miro O, Martin-Sanchez F, Cullen L, Christ M, Di Somma S, Peacock F, Osswald S, Reichlin T, Mueller C. P469Pro-hormones in the early diagnosis of cardiac syncope. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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25
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Kuhn L, Page K, Nedkoff L, Chew D, Ellis C, Cullen L, Hyun K, Farouque O, Redfern J, Astley C. A Gender-Based Comparison of Management, In-Hospital and Late Outcomes for Patients with Acute Coronary Syndrome in Australia and New Zealand: Results from the SNAPSHOT ACS Audit. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Lancini D, Martin P, Cullen L, Greenslaide J, Hammett J, Prasad S, Than M, Parsonage W. Prognostic impact of atrial fibrillation in the emergency chest pain presentation. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Milburn T, Ashover S, Skoien W, Cullen L, Greenslade J, Parsonage W. A Large Scale Implementation of the Adapt Accelerated Diagnostic Protocol into Clinical Practice in Queensland: Impact on Hospital Length of Stay and Admission Rates for Possible Cardiac Chest Pain. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Parsonage WA, Mueller C, Greenslade JH, Wildi K, Pickering J, Than M, Aldous S, Boeddinghaus J, Hammett CJ, Hawkins T, Nestelberger T, Reichlin T, Reidt S, Rubin Gimenez M, Tate JR, Twerenbold R, Ungerer JP, Cullen L. Validation of NICE diagnostic guidance for rule out of myocardial infarction using high-sensitivity troponin tests. Heart 2016; 102:1279-86. [PMID: 27288278 DOI: 10.1136/heartjnl-2016-309270] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 05/16/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To validate the National Institute for Health and Care Excellence (NICE) recommended algorithms for high-sensitivity troponin (hsTn) assays in adults presenting with chest pain. METHODS International post hoc analysis of three prospective, observational studies from tertiary hospital emergency departments. The primary endpoint was cardiac death or acute myocardial infarction (AMI) within 24 hours of presentation, and the secondary endpoint was major adverse cardiac events (MACE) at 30 days. RESULTS 15% of patients were diagnosed with non-ST elevation myocardial infarction (MI) on admission. The hsTnI algorithm classified 2506/3128 (80.1%) of patients as 'ruled out' with 50 (2.0%) missed MI. 943/3128 (30.1%) of patients had a troponin I level below the limit of detection on admission with 2 (0.2%) missed MI. For the hsTnT algorithm, 1794/3374 (53.1%) of patients were 'ruled out' with 7 (0.4%) missed MI. 490/3374 (14.5%) of patients had a troponin T below the limit of blank on admission with no MI. MACE at 30 days occurred in 10.7% and 8.5% of patients 'ruled out' defined by the hsTnI and hsTnT algorithms, respectively. CONCLUSIONS The NICE algorithms could identify patients with low probability of AMI within 2 hours; however, neither strategy performed as predicted by the NICE diagnostic guidance model. Additionally, the rate of MACE at 30 days was sufficiently high that the algorithms should only be used as one component of a more extensive model of risk stratification. TRIAL REGISTRATION NUMBER ACTRN12611001069943, NCT00470587; post-results.
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Affiliation(s)
- W A Parsonage
- Royal Brisbane & Women's Hospital, Herston, Australia
| | - C Mueller
- Cardiovascular Research Institute, University Hospital, Basel, Switzerland
| | | | - K Wildi
- Cardiovascular Research Institute, University Hospital, Basel, Switzerland
| | - J Pickering
- Christchurch Hospital, Christchurch, New Zealand
| | - M Than
- Christchurch Hospital, Christchurch, New Zealand
| | - S Aldous
- Christchurch Hospital, Christchurch, New Zealand
| | - J Boeddinghaus
- Cardiovascular Research Institute, University Hospital, Basel, Switzerland
| | - C J Hammett
- Royal Brisbane & Women's Hospital, Herston, Australia
| | - T Hawkins
- Royal Brisbane & Women's Hospital, Herston, Australia
| | - T Nestelberger
- Cardiovascular Research Institute, University Hospital, Basel, Switzerland
| | - T Reichlin
- Cardiovascular Research Institute, University Hospital, Basel, Switzerland
| | - S Reidt
- Cardiovascular Research Institute, University Hospital, Basel, Switzerland
| | - M Rubin Gimenez
- Cardiovascular Research Institute, University Hospital, Basel, Switzerland
| | - J R Tate
- Royal Brisbane & Women's Hospital, Herston, Australia
| | - R Twerenbold
- Cardiovascular Research Institute, University Hospital, Basel, Switzerland
| | - J P Ungerer
- Royal Brisbane & Women's Hospital, Herston, Australia
| | - L Cullen
- Royal Brisbane & Women's Hospital, Herston, Australia
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Sahadevan A, Baily C, Cullen L, Kooblall M, Watchorn DC, Lane SJ, Moloney E. The Efficacy of COPD Outreach in Reducing Length of Stay and Improving Quality of Life. Ir Med J 2015; 108:169-171. [PMID: 26182798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
COPD exacerbations results in prolonged hospitalisation, re-admissions, reduces health-related quality of life (HRQoL) and increases mortality. The study aimed to assess the efficacy of a COPD Outreach service in reducing average length of stay (ALOS), reducing readmissions within 90 days of admission, improving HRQoL and reducing mortality among COPD patients with acute exacerbations (AECOPD). AECOPD data for a 2 year period commencing September 2011 was analysed. The COPD Assessment test (CAT) quantified HRQoL at enrolment and 6 weeks post Outreach. COPD Outreach had an ALOS of 2.47 days compared to ALOS 8.59 days and 8.5 days for all AECOPD before and during an operational COPD Outreach. Re-admission rates among patients enrolled in COPD Outreach were 36.3%. CAT improved from mean 19.3 to 13.5. Mortality was 4.9% among Outreach patients and 2.5% for overall AECOPD in 2012-2013. COPD Outreach reduced ALOS and improved HRQoL for selected patients with AECOPD. It did not reduce re-admissions or mortality.
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Greenslade J, Kavsak P, Parsonage W, Shortt C, Than M, Pickering J, Aldous S, Cullen L. Combining presentation high-sensitivity cardiac troponin I and glucose measurements to rule-out an acute myocardial infarction in patients presenting to emergency department with chest pain. Clin Biochem 2015; 48:288-91. [DOI: 10.1016/j.clinbiochem.2014.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
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Etaher A, Chew D, Briffa T, Ellis C, Hammett C, Redfern J, Lefkovits J, Elliott J, Cullen L, Brieger D, French J. Cardiac troponin type II myocardial infarction and late mortality: a report from the 2012 SNAPSHOT OF ACS Care Across Australia and New Zealand. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Menzies L, Cullen L, Greenslade J, Leong A, Than M, Pemberton C, Aldous S, Pickering J, Crosling B, Foreman R, Parsonage W. The association of delay in presentation and 12-month health outcomes in emergency patients with symptoms of possible acute coronary syndromes. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cullen L, Schaffer K, Callaghan M, McClean S. 52 Burkholderia cenocepacia shows increased attachment to cystic fibrosis lung epithelial cells over time of colonisation. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60189-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cullen L, Parsonage W, Greenslade J, Aldous S, George P, Lamanna A, Ungerer J, Richards M, Pemberton CJ, Than M. Diagnostic accuracy of highly sensitive troponin I versus highly sensitive troponin T assays for acute myocardial infarction within two hours of emergency department presentation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cullen L, Parsonage W, Greenslade J, Aldous S, George P, Lamanna A, Ungerer J, Richards M, Pemberton CJ, Than M. Use of sex-specific cut-offs with highly sensitive troponin I assay values for the diagnosis of acute myocardial infarction in emergency patients with chest pain. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cullen L, Parsonage W, Greeenslade J, Aldous S, George P, Hammett C, Lamanna A, Ungerer J, Richards M, Pemberton C, Than M. Diagnosis of Acute Myocardial Infarction in Emergency Patients with Chest Pain Using a Two Hour Algorithm with Highly Sensitive Troponin I Assay Results. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cullen L, Greenslade J, Than M, Aldous S, George P, Hawkins T, Brown A, Richards M, Pemberton C, Hammett C, Parsonage W. Identification of Low Risk Emergency Patients with Symptoms of Possible Acute Coronary Syndrome: External Validation of the Vancouver Chest Pain Rule. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Parsonage W, Greenslade J, Ungerer J, Tate J, Pretorius C, Hammett C, Lamanna A, Chu K, Brown A, Cullen L. A Study of the Effect of the Manufacturers Advised Recalculation of the High Sensitivity Troponin T Assay on the Early Detection of Acute Myocardial Infarction in Patients Presenting to the Emergency Department. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Parsonage W, Cullen L, Greenslade J, Aldous S, George P, Lamanna A, Hammett C, Ungerer J, Pemberton C, Richards M, Than M. A Study Comparing Diagnostic Accuracy of High Sensitivity Assays of Troponin I and Troponin T for Myocardial Infarction Within Two Hours of Presentation to the Emergency Room. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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George T, Cullen L, Parsonage W, Larsen P, Coverdale S, Ashover S, Bilesky J, Bailey K, Boulton B, Gibson J, Currie J. Use of an Accelerated Diagnostic Protocol in the Assessment of Emergency Department Patients with Possible Acute Coronary Syndrome. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Values for galactose and indocyanine green (ICG) clearances, and plasma and serum biochemical markers of liver dysfunction were determined in normal chickens and following coeliotomy, and compared with birds after partial hepatectomy. Clearance tests, and serum and plasma biochemistry were performed 4h, and 4 and 7 days after surgery. Coeliotomy and manipulation of the liver did not delay clearance of either compound. Partial hepatectomy resulted in elevation of galactose single point concentrations but did not significantly alter galactose clearance (GEC) values. Clearance values of ICG were not significantly altered. Biochemical values were not significantly elevated in birds after a partial hepatectomy in comparison with birds after coeliotomy. Galactose single point concentrations have the potential to become a simple, relatively non-invasive method of screening for liver disease, with GEC tests having the potential to quantify the degree of loss of functional hepatic mass.
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Totzeck M, Hendgen-Cotta U, Rammos C, Petrescu A, Stock P, Goedecke A, Shiva S, Kelm M, Rassaf T, Duerr GD, Heuft T, Klaas T, Suchan G, Roell W, Zimmer A, Welz A, Fleischmann BK, Dewald O, Luedde M, Carter N, Lutz M, Sosna J, Jacoby C, Floegel U, Hippe HJ, Adam D, Heikenwaelder M, Frey N, Sobierajski J, Luedicke P, Hendgen-Cotta U, Lue H, Totzeck M, Dewor M, Kelm M, Bernhagen J, Rassaf T, Cortez-Dias N, Costa M, Carrilho-Ferreira P, Silva D, Jorge C, Robalo Martins S, Fiuza M, Pinto FJ, Nunes Diogo A, Enguita FJ, Tsiachris D, Tsioufis C, Kasiakogias A, Flessas D, Antonakis V, Kintis K, Giakoumis M, Hatzigiannis P, Katsimichas T, Stefanadis C, Andrikou E, Tsioufis C, Thomopoulos C, Kasiakogias A, Tzamou V, Andrikou I, Bafakis I, Lioni L, Kintis K, Stefanadis C, Lazaros G, Tsiachris D, Tsioufis C, Vlachopoulos C, Brili S, Chrysohoou C, Tousoulis D, Stefanadis C, Santos De Sousa CI, Pires S, Nunes A, Cortez Dias N, Belo A, Cabrita I, Pinto FJ, Benova T, Radosinska J, Viczenczova C, Bacova B, Knezl V, Dosenko V, Navarova J, Zeman M, Tribulova N, Maceira Gonzalez AM, Cosin Sales J, Igual B, Ruvira J, Diago JL, Aguilar J, Lopez Lereu MP, Monmeneu JV, Estornell J, Choi JC, Cha KS, Lee HW, Yun EY, Ahn JH, Oh JH, Choi JH, Lee HC, Hong TJ, Manzano Fernandez S, Lopez-Cuenca A, Januzzi JL, Mateo-Martinez A, Sanchez-Martinez M, Parra-Pallares S, Orenes-Pinero E, Romero-Aniorte AI, Valdes-Chavarri M, Marin F, Bouzas Mosquera A, Peteiro J, Broullon FJ, Alvarez Garcia N, Couto Mallon D, Bouzas Zubeldia B, Martinez Ruiz D, Yanez Wonenburger JC, Fabregas Casal R, Castro Beiras A, Backus BE, Six AJ, Cullen L, Greenslade J, Than M, Kameyama T, Sato T, Noto T, Nakadate T, Ueno H, Yamada K, Inoue H, Albrecht-Kuepper B, Kretschmer A, Kast R, Baerfacker L, Schaefer S, Kolkhof P, Andersson C, Kober L, Christensen SB, Nguyen CD, Nielsen MB, Olsen AMS, Gislason GH, Torp-Pedersen C, Shigekiyo M, Harada K, Lieu H, Neutel J, Maddock S, Goldsmith S, Koren M, Antwerp BV, Burnett J, Christensen SB, Charlot MG, Madsen M, Andersson C, Kober L, Gustafsson F, Torp-Pedersen C, Gislason GH, Cavusoglu Y, Mert KU, Nadir A, Mutlu F, Gencer E, Ulus T, Birdane A, Lim HS, Tahk SJ, Yang HM, Kim JW, Seo KW, Choi BJ, Choi SY, Yoon MH, Hwang GS, Shin JH, Russ MA, Wackerl C, Hochadel M, Brachmann J, Mudra H, Zeymer U, Weber MA, Menozzi A, Saia F, Valgimigli M, Belotti LM, Casella G, Manari A, Cremonesi A, Piovaccari G, Guastaroba P, Marzocchi A, Kuramitsu S, Iwabuchi M, Haraguchi T, Domei T, Nagae A, Hyodo M, Takabatake Y, Yokoi H, Toyota F, Nobuyoshi M, Kaitani K, Hanazawa K, Izumi C, Nakagawa Y, Ando K, Arita T, Nobuyoshi M, Shizuta S, Kimura T, Isshiuki T, Trucco ME, Tolosana JM, Castel MA, Borras R, Sitges M, Khatib M, Arbelo E, Berruezo A, Brugada J, Mont L, Romanov A, Pokushalov E, Prokhorova D, Chernyavskiy A, Shabanov V, Goscinska-Bis K, Bis J, Bochenek A, Gersak B, Karaskov A, Linde C, Daubert C, Bergemann TL, Abraham WT, Gold MR, Van Boven N, Bogaard K, Ruiter JH, Kimman GP, Kardys I, Umans VA, Cipriani M, Lunati M, Landolina M, Vittori C, Vargiu S, Ghio S, Petracci B, Campo C, Bisetti S, Frigerio M, Bongiorni MG, Soldati E, Segreti L, Zucchelli G, Di Cori A, De Lucia R, Viani S, Paperini L, Boem A, Levorato D, Kutarski A, Malecka B, Zabek A, Czajkowski M, Chudzik M, Kutarski A, Mitkowski P, Maciag A, Kempa M, Golzio PG, Fanelli A, Vinci M, Pelissero E, Morello M, Grosso Marra W, Gaita F, Kutarski A, Czajkowski M, Pietura R, Golzio PG, Vinci M, Pelissero E, Fanelli A, Ferraris F, Gaita F, Cuypers JAAE, Menting ME, Opic P, Utens EMWJ, Van Domburg RT, Helbing WA, Witsenburg M, Van Den Bosch AE, Bogers AJJC, Roos-Hesselink JW, Van Der Linde D, Takkenberg JJM, Rizopoulos D, Heuvelman HJ, Witsenburg M, Budts W, Van Dijk APJ, Bogers AJJC, Oechslin EN, Roos-Hesselink JW, Diller GP, Kempny A, Liodakis E, Alonso-Gonzalez R, Orwat S, Dimopoulos K, Swan L, Li W, Gatzoulis MA, Baumgartner H, Andrade AC, Voges I, Jerosch-Herold M, Pham M, Hart C, Hansen T, Kramer HH, Rickers C, Kempny A, Wustmann K, Borgia F, Dimopoulos K, Uebing A, Piorkowski A, Yacoub MH, Gatzoulis MA, Swan L, Diller GP, Mueller J, Weber R, Pringsheim M, Hoerer J, Hess J, Hager A, Hu K, Liu D, Niemann M, Herrmann S, Cikes M, Stoerk S, Knob S, Ertl G, Bijnens B, Weidemann F, Mornos C, Cozma D, Dragulescu D, Ionac A, Mornos A, Petrescu L, Mingo S, Ruiz Bautista L, Monivas Palomero V, Prados C, Maiz L, Giron R, Martinez M, Cavero Gibanel MA, Segovia J, Pulpon L, Kato H, Kubota S, Takasawa Y, Kumamoto T, Iacoviello M, Puzzovivo A, Forleo C, Lattarulo MS, Monitillo F, Antoncecchi V, Malerba G, Marangelli V, Favale S, Ruiz Bautista L, Mingo S, Monivas V, Segovia J, Prados C, Maiz L, Giron R, Martinez MT, Gonzalez Estecha M, Alonso Pulpon LA, Ren B, De Groot-De Laat L, Mcghie J, Vletter W, Ten Cate F, Geleijnse M, Looi JL, Lam YY, Yu CM, Lee PW, Apor A, Sax B, Huttl T, Nagy A, Kovacs A, Merkely B, Vecera J, Bartunek J, Vanderheyden M, Mertens P, Bodea O, Penicka M, Biaggi P, Gaemperli O, Corti R, Gruenenfelder J, Felix C, Bettex D, Datta S, Jenni R, Tanner F, Herzog B, Fattouch K, Murana G, Castrovinci S, Sampognaro R, Bertolino EC, Caccamo G, Ruvolo G, Speziale G, Lancellotti P. Saturday, 25 August 2012. Eur Heart J 2012. [DOI: 10.1093/eurheartj/ehs280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Smyth B, Evans DS, Kelly A, Cullen L, O'Donovan D. The farming population in Ireland: mortality trends during the 'Celtic Tiger' years. Eur J Public Health 2012; 23:50-5. [DOI: 10.1093/eurpub/cks017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cullen L, Parsonage W, Greenslade J, Lamanna A, Hammett C, Than M, Tate J, Kalinowski L, Ungerer J, Chu K, Brown A. Delta Troponin for the Diagnosis of AMI: Comparison of 2 and 6h Metrics Using a Contemporary Troponin Assay for Emergency Department Patients with Chest Pain. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bilesky J, Cullen L, Greenslade J, Lamanna A, Hammett C, Brown A, Chu K, Parsonage W. Prospective Observational Validation of the Heart Foundation of Australia (HF)/Cardiac Society of Australian and New Zealand (CSANZ) Risk Stratification Tool in Patients Presenting to the Emergency Department with Acute Chest Pain. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lamanna A, Scott A, Bilesky J, Cullen L, Greenslade J, Brown A, Denaro C, Parsonage W. The Utility of Exercise Stress Test in the Risk Stratification of Women Aged 40–54 Years with Suspected Intermediate Risk Acute Coronary Syndrome. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bilesky J, Younger J, Parsonage W, Greenslade J, Lamanna A, Hammett C, Brown A, Chu K, Cullen L. Suitability of Emergency Department (ED) Patients with Undifferentiated Chest Pain for CT Coronary Angiography (CTCA). Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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48
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Cullen L, Parsonage W, Greenslade J, Lamanna A, Hammett C, O’Kane S, Chu K, Brown A. Comparison of Early Biomarker Strategies with the Heart Foundation of Australia/Cardiac Society of Australia and New Zealand Guidelines (HFA/CS-ANZ) for Risk Stratification of Emergency Department Patients Presenting with Chest Pain. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lamanna A, Scott A, Bilesky J, Greenslade J, Cullen L, Denaro C, Brown A, Parsonage W. Limited Utility of Exercise Stress Test in the Evaluation of Suspected Acute Coronary Syndrome in Patients Aged Less Than 40 Years with Intermediate Risk Features. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hunter J, Hammett C, Cullen L, Greenslade J, Brown A, Chu K, Parsonage W. Indeterminate Troponin Elevations Have Poor Positive Predictive Value for Acute Coronary Syndrome in an Emergency Department population. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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