Objective: Chest pain is a prevalent and potentially life-threatening presentation in emergency departments, necessitating prompt and precise risk stratification to identify patients at high risk, particularly those with acute coronary syndrome (ACS). This study evaluates the predictive accuracy of the HEART score in stratifying short-term major adverse cardiac events (MACE) risk among chest pain patients in Bandar Abbas, aiming to enhance clinical decision-making and resource utilization in emergency departments. Method: This prospective observational study was conducted on patients presenting with chest pain at Shahid Mohammadi Hospital’s emergency department. Patients aged ≥18 years with chest pain were included, while those with STEMI or incomplete records were excluded. The HEART score was used for risk stratification, and patients were classified into low, moderate, or high-risk groups. The primary outcome was MACE within six weeks, confirmed via follow-up calls. Data analysis included logistic regression and ROC curve analysis. Result: A total of 1,501 individuals participated in the study, with a mean age of 48.99±14.71 years. Among the participants, 28.6% were diagnosed with MACE. The most common risk factors for MACE included a history of coronary artery disease (79.1%) and hypertension (77.2%). Based on the HEART score, patients were categorized into low-risk (≤ 3), moderate-risk (4-6), and high-risk (≥ 7) groups. The majority of non-MACE patients were classified as low-risk (78.3%), while 65.6% of MACE patients fell into the moderate-risk category. The mean HEART score was significantly higher in the MACE group (5.73±1.68) compared to the non-MACE group (2.31± 1.54). The optimal HEART score cutoff for predicting MACE was determined to be 3.5, with the ROC curve demonstrating strong predictive performance (AUC=0.932). Conclusion: The HEART score is a reliable tool for risk stratification in chest pain patients in the emergency department. Our study shows that a score of ≤ 3.5 indicates low risk, while higher scores predict a greater likelihood of MACE. The HEART score effectively guides clinical decisions, highlighting its high sensitivity and specificity for identifying low- and high-risk patients, making it an essential tool for patient management in emergency settings.
Objective: Religious mass gatherings in Iraq attract millions of pilgrims and have significant public health challenges. The martyrdom anniversary of Imam Ali bin Abi Talib (peace be upon him) in Najaf involves high population density and potential health risks. However, limited data exists on the spectrum of patient presentations during this event. Methods: It was a cross-sectional study in 12 health facilities (10 temporary mobile clinics and 2 fixed centers) established in Najaf for the event. The study was conducted from March 29 to April 1, 2024 (18–21 Ramadan 1445H). Data was collected by convenience sampling, entered via KoboToolbox, and analyzed in SPSS version 26 using descriptive statistics and chi-squared tests. Results: A total of 8,959 patients were registered. Most were aged 31–60 years (58.2%) and Iraqi nationals (80.8%). The most common acute infectious presentation was pharyngitis (16.7%: 95% CI: 15.9,17.4), followed by acute diarrhea (3.2%: 95% CI: 2.9,3.6). Noncommunicable conditions included hypertension (11.5%; 95% CI: 10.9,12.2), and diabetes mellitus (7.9%; 95% CI: 7.3,8.4). Patient presentations varied significantly by age group and nationality (P< 0.001). Conclusion: Pharyngitis was the leading acute presentation, suggesting a risk of respiratory disease transmission. Chronic conditions, particularly hypertension and diabetes, especially among adults over 31 years. These findings highlight the need for preparedness of temporary clinics to manage both communicable and noncommunicable diseases during religious mass gatherings in Iraq.
Backgound: Approximately one-third of the spontaneous bacterial peritonitis (SBP) are missed due to the absence of paracentesis, and any delay in antibiotic initiation significantly increases mortality. Clinical decision tools may help to rule out or rule in the diagnosis without paracentesis. This study systematically reviewed the performance of available decision tools for diagnosing SBP in adult patients with cirrhosis. Methods: We included all original studies that evaluated clinical decision tools for SBP diagnosis. Search was conducted in MEDLINE, Embase, Scopus, and Web of Science Core Collection from inception to September 2024. Study quality was evaluated using Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS 2). Results: From 2038 records, 44 articles were scrutinized in full text. Twenty-four studies ultimately met eligibility criteria. Most of the studies were at low risk of bias. Several tools relied on laboratory findings with clinical features. In meta-analysis the Mansoura scoring system (cut-off of 4) showed a pooled sensitivity of 70.96% (95% CI: 42.06%,99.86%) and a negative predictive value 92.27% (95% CI: 88.80%,95.74%). The Wehmeyer’s scoring system achieved pooled specificity and positive predictive value of 98.43% (95% CI: 95.29,101.58%) and 90.26% (95% CI: 70.28,110.23%). A MELD score >15 yielded had pooled sensitivity of 83.85% (95% CI: 78.50%,89.20%) and negative predictive value of 87.56% (95% CI: 81.29%,93.84%). Conclusion: Several decision tools, particularly laboratory-based (e.g. procalcitonin) tools, showed high sensitivity to potentially rule out SBP. Some other tools (e.g. Mansoura, Wehmeyer rules) can reliably rule in the diagnosis. However, tools all the tools need further validation before widespread adoption.
