Development and Validation of a Prediction Model on Adult Emergency Department Patients for Early Identification of Fulminant Myocarditis

Objective It is difficult to predict fulminant myocarditis at an early stage in the emergency department.The objective of this study was to construct and validate a simple prediction model for the early identification of fulminant myocarditis.Methods A total of 61 patients with fulminant myocarditis and 160 patients with acute myocarditis were enrolled in the training and internal validation cohorts.LASSO regression and multivariate logistic regression were selected to develop the prediction model.The selection of the model was based on overall performance and simplicity.A nomogram based on the optimal model was built,and its clinical usefulness was evaluated by decision curve analysis.The predictive model was further validated in an external validation group.Results The resulting prediction model was based on 4 factors:systolic blood pressure,troponin I,left ventricular ejection fraction,and ventricular wall motion abnormality.The Brier scores of the final model were 0.078 in the training data set and 0.061 in the internal testing data set,respectively.The C-indexes of the training data set and the testing data set were 0.952 and 0.968,respectively.Decision curve analysis showed that the nomogram model developed based on the 4 predictors above had a positive net benefit for predicting probability thresholds.In the external validation cohort,the model also showed good performance(Brier score=0.007,and C-index=0.989).Conclusion We developed and validated an early prediction model consisting of 4 clinical factors(systolic blood pressure,troponin I,left ventricular ejection fraction,and ventricular wall motion abnormality)to identify potential fulminant myocarditis patients in the emergency department.

Correlations between quality indexes of chest compression

BACKGROUND:Cardiopulmonary resuscitation(CPR) is a kind of emergency treatment for cardiopulmonary arrest,and chest compression is the most important and necessary part of CPR.The American Heart Association published the new Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in 2010 and demanded for better performance of chest compression practice,especially in compression depth and rate.The current study was to explore the relationship of quality indexes of chest compression and to identify the key points in chest compression training and practice.METHODS:Totally 219 healthcare workers accepted chest compression training by using Laerdal ACLS advanced life support resuscitation model.The quality indexes of chest compression,including compression hands placement,compression rate,compression depth,and chest wall recoil as well as self-reported fatigue time were monitored by the Laerdal Computer Skills and Reporting System.RESULTS:The quality of chest compression was related to the gender of the compressor.The indexes in males,including self-reported fatigue time,the accuracy of compression depth and the compression rate,the accuracy of compression rate,were higher than those in females.However,the accuracy of chest recoil was higher in females than in males.The quality indexes of chest compression were correlated with each other.The self-reported fatigue time was related to all the indexes except the compression rate.CONCLUSION:It is necessary to offer CPR training courses regularly.In clinical practice,it might be better to change the practitioner before fatigue,especially for females or weak practitioners.In training projects,more attention should be paid to the control of compression rate,in order to delay the fatigue,guarantee enough compression depth and improve the quality of chest compression.

Factors Influencing Pre-hospital Patient Delay in Patients with Acute Myocardial Infarction

Acute myocardial infarction （AMI） is a dangerous disease with a high mortality rate. For AMI patients, the outcome of the patients depends on time to beginning of effective treatment in addition to other factors such as severity of disease and involved vessels etc. The key is whether reperfusion therapy is started early enough after the onset of symptoms, and the benefit of reperfusion therapy depends on the time, too. The delay of AMI treatment is divided into pre-hospital delay and in-hospital delay. In-hospital delay, Door-to-Balloon Time, has been well controlled. Pre-hospital delay, accounting for 75% of the total delay time, is the most important factor affect- ing AMI treatment. Patient delay （PD） time for AMI patients is summarised in this study.