Background Chest pain remains one of the most challenging serious complaints in the emergency department (ED). A prompt and accurate risk stratification tool for chest pain patients is paramount to help physcian effectively progrnosticate outcomes. HEART score is considered one of the best scores for chest pain risk stratification. However, most validation studies of HEART score were not performed in populations different from those included in the original one. Objective To validate HEART score as a prognostication tool, among Tunisian ED patients with undifferentiated chest pain. Methods Our prospective, multicenter study enrolled adult patients presenting with chest pain at chest pain units. Patients over 30 years of age with a primary complaint of chest pain were enrolled. HEART score was calculated for every patient. The primary outcome was major cardiovascular events (MACE) occurrence, including all-cause mortality, non-fatal myocardial infarction (MI), and coronary revascularisation over 30 days following the ED visit. The discriminative power of HEART score was evaluated by the area under the ROC curve. A calibration analysis of the HEART score in this population was performed using Hosmer–Lemeshow goodness of test. Results We enrolled 3880 patients (age 56.3; 59.5% males). The application of HEART score showed that most patients were in intermediate risk category (55.3%). Within 30 days of ED visit, MACE were reported in 628 (16.2%) patients, with an incidence of 1.2% in the low risk group, 10.8% in the intermediate risk group and 62.4% in the high risk group. The area under receiver operating characteristic curve was 0.87 (95% CI 0.85–0.88). HEART score was not well calibrated (χ2 statistic = 12.34; p = 0.03). Conclusion HEART score showed a good discrimination performance in predicting MACE occurrence at 30 days for Tunisian patients with undifferentiated acute chest pain. Heart score was not well calibrated in our population.
Objective: To determine the impact of mobile-phone telemonitoring on patients’ adherence and satisfaction to post-trauma pain treatment. Materials and Methods: We conducted a prospective randomized clinical trial including patients with minor trauma discharged from the emergency department (ED) with analgesic treatment. Patients were randomized to one of three groups, control group where patients received a phone call on day-7, short message service (SMS) group where patients received a daily text message to remind them to take their treatment during 7 days and mobile-phone based telemonitoring (TLM) group. Patients’ adherence to analgesic treatments using the Morisky Medication Adherence Scale (MMAS-4), current pain by using a visual analogue scale (VAS) and patients’ satisfaction were assessed. For TLM group, assessment was performed at day-2, 4 and 7. Results: Good adherence was observed in 418 patients (92.9%) in TLM group versus 398 patients (88.6%) in SMS group and 380 patients (84.8%) in control group (P<0.001). The factor mostly associated with adherence was telemonitoring (OR 2.40 95% CI 1.55 to 3.71). The decrease of pain VAS was highest in TLM group compared to SMS and control groups (P<0.001). Percentage of patients’ satisfaction at 7-day post ED discharge was 93% in TLM group vs 88% in SMS group and 84% in standard group (P=0.02). Discussion: Our findings suggest that mobile-phone based telemonitoring is beneficial in the treatment of pain in trauma patients after ED discharge. This approach improved patients’ adherence and satisfaction.
Objective The study compared the efficacy and tolerability of piroxicam gel and a new topical combination of medicinal plant products (Soulagel®) to treat pain caused by soft tissue injuries. Methods 1525 patients were assigned to receive piroxicam gel or Soulagel®. Efficacy assessments included pain-on-movement (POM) VNS (visual numeric scale) change from emergency department (ED) discharge (baseline) by at least 50% at day-7 final assessment, the time required to reach pain resolution criteria, need for rescue analgesia, patients’ satisfaction, and rate of adverse effects. Results At day-7, 1216 patients (79.7%) achieved at least 50% reduction of VNS from baseline; 623 patients (82.4%) in Soulagel® group vs. 593 patients (77.1%) in piroxicam group (p = 0.01). Time to decrease POM by 50% was significantly higher with piroxicam gel compared to Soulagel® (34±1 vs 33±1 days respectively; p = 0.54). At day 7, 96.4% of patients in Soulagel® group declared being “very satisfied” to “satisfied” vs. 68% in piroxicam group (p < 0.001). There was no major adverse events in both groups. Conclusion Soulagel® is not inferior to piroxicam gel for managing pain related to a soft tissues injuries. Further studies will help ascertain whether this new gel offers an alternative treatment option in this common ED condition.
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