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Diagnostic pitfalls...
Diagnostic pitfalls at admission in patients with acute superior mesenteric artery occlusion
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- Acosta, Stefan (författare)
- Lund University,Lunds universitet,Vaskulära sjukdomar - kliniska studier,Forskargrupper vid Lunds universitet,Vascular Diseases - Clinical Research,Lund University Research Groups
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- Block, Tomas (författare)
- Uppsala universitet,Kärlkirurgi
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- Björnsson, Steinarr (författare)
- Lund University,Lunds universitet,Vaskulära sjukdomar - kliniska studier,Forskargrupper vid Lunds universitet,Vascular Diseases - Clinical Research,Lund University Research Groups
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- Resch, Timothy (författare)
- Vascular Center, Malmö University Hospital, Malmö, Sweden,Kärlcentrum, Malmö Universitetssjukhus
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- Björck, Martin (författare)
- Uppsala universitet,Kärlkirurgi
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- Nilsson, Torbjörn, 1956- (författare)
- Örebro universitet,Institutionen för hälsovetenskap och medicin,Department of Clinical Chemistry, Örebro University Hospital, Örebro, Sweden,Sektionen för Klinisk kemi, Örebro universitetssjukhus
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(creator_code:org_t)
- Elsevier, 2012
- 2012
- Engelska.
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Ingår i: Journal of Emergency Medicine. - : Elsevier. - 0736-4679 .- 1090-1280. ; 42:6, s. 635-641
- Relaterad länk:
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http://www.ncbi.nlm....
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http://dx.doi.org/10...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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https://urn.kb.se/re...
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https://urn.kb.se/re...
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https://lup.lub.lu.s...
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Abstract
Ämnesord
Stäng
- BACKGROUND: Acute superior mesenteric artery (SMA) occlusion leads to acute intestinal ischemia and is associated with high mortality. Early diagnosis is often missed, and confounding factors leading to diagnostic delays need to be highlighted.OBJECTIVES: To identify potential diagnostic laboratory pitfalls at admission in patients with acute SMA occlusion.METHODS: Fifty-five patients with acute SMA occlusion were identified from the in-hospital register during a 4-year period, 2005-2009.RESULTS: The median age was 76 years; 78% were women. The occlusion was embolic in 53% and thrombotic in 47% of patients. At admission, troponin I was above the clinical decision level (> 0.06 μg/L) for acute ischemic myocardial injury in 9/19 (47%) patients with embolic occlusion. Elevated pancreas amylase and normal plasma lactate were found in 12/45 and 13/27, respectively. A troponin I (TnI) above the clinical decision level was associated with a high frequency of referrals from the general surgeon to a specialist in internal medicine (p = 0.011) or a cardiologist (p = 0.024). The diagnosis was established after computed tomography angiography in 98% of the patients. The overall in-hospital mortality rate was 33%. Attempting intestinal revascularization (n = 43; p < 0.001), with a 95% frequency rate of completion control of the vascular procedure, was associated with a higher survival rate, whereas referral to the cardiologist was associated with a higher mortality rate (p = 0.018).CONCLUSION: Elevated TnI was common in acute SMA occlusion, and referral to the cardiologist was found to be associated with adverse outcome. Elevated pancreas amylase and normal plasma lactate values are also potential pitfalls at admission in patients with acute SMA occlusion.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
Nyckelord
- diagnostic pitfalls; troponin; amylase; lactate; superior mesenteric artery; occlusion
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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