If not chest pain, sob and exam is normal; almost all of my attendings give them their home meds early or nothing if its new or have already taken their meds. tell them to see their PCP tomorrow or give them the health clinic number.
Utility of Routine Testing for Patients With Asymptomatic Severe Blood Pressure Elevation in the Emergency Department
Presented at the Society for Academic Emergency Medicine annual meeting, May 2006, San Francisco, CA.
David J. Karras, MDa, , , Linda K. Kruus, PhDa, John J. Cienki, MDc, Marlena M. Wald, MLS, MPHb, Jacob W. Ufberg, MDa, Philip Shayne, MDb, David A. Wald, DOa, Katherine L. Heilpern, MDb
a Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, PA
b Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
c Department of Emergency Medicine, Jackson Memorial Hospital–University of Miami School of Medicine, Miami, FL.
Received 30 November 2006. Revised 15 March 2007. Accepted 26 March 2007. Available online 11 May 2007.
http://dx.doi.org.libproxy.temple.edu/10.1016/j.annemergmed.2007.03.032, How to Cite or Link Using DOI
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Study objective
Recommendations for the treatment of emergency department (ED) patients with asymptomatic severely elevated blood pressure advise assessment for occult, acute hypertensive target-organ damage. This study determines the prevalence of unanticipated, clinically meaningful test abnormalities in ED patients with asymptomatic severely elevated blood pressure.
Methods
This was a prospective observational study at 3 urban academic EDs. Consecutive patients with systolic blood pressure greater than or equal to 180 mm Hg or diastolic blood pressure greater than or equal to 110 mm Hg on 2 measurements were enrolled if they denied symptoms of hypertensive emergency. A basic metabolic panel, urinalysis, ECG, CBC count, and chest radiograph were obtained. Treating physicians were interviewed about the indication for each test and whether an abnormal result was anticipated according to clinical findings. When test results were available, physicians were asked whether abnormal findings were clinically meaningful, defined as leading to unanticipated hospitalization, medication modification, or further immediate evaluation. The primary outcome was the prevalence of unanticipated clinically meaningful test abnormalities.
Results
One hundred nine patients with asymptomatic severely elevated blood pressure were enrolled. Unanticipated abnormal test results were noted in 57 (52%) patients. Clinically meaningful unanticipated test abnormalities were found in 7 (6%) patients: basic metabolic panel in 2 (2%), CBC count in 3 (3%), urinalysis in 3 (4%), ECG in 2 (2%), and chest radiograph in 1 (1%). Five patients (5%) had abnormalities assessed as possible manifestations of acute hypertensive target-organ injury; none had abnormalities clearly related to severely elevated blood pressure.
Conclusion
Screening tests of urban ED patients with asymptomatic severely elevated blood pressure infrequently detect unanticipated hypertension-related abnormalities that alter ED management.
