Doctoral defence: Triinu Keskpaik „Quality Indicators and Non-Ischemic Myocardial Injury in Emergency Medicine“

On December 15 at 14 Triinu Keskpaik will defend her doctoral thesis „Quality Indicators and Non-Ischemic Myocardial Injury in Emergency Medicine“. 

Supervisors:
Professor Joel Starkopf, Tartu Ülikool
Professor Peep Talving, Tartu Ülikool 

Opponent:
Professor Beat Schnüriger, Berni Ülikooli haigla (Šveits). 

Summary:
Emergency medicine plays a crucial role in healthcare, encompassing functions such as the initial treatment of critical conditions, the diagnosis and prevention of organ failures, and the subsequent reduction of mortality and disability rates. In Estonia, emergency medicine was established as an independent medical specialty in the year 2000. Over the years, the country has developed an emergency medical care network, implemented a triage system for patients, introduced a specialty residency program, and taken steps to assess quality of care. However, like healthcare systems around the world, Estonia's emergency medicine system faces growing demand and department overcrowding, potentially resulting in harmful delays for patients. 

Current research has focused on two patient groups at the emergency department (ED): those presenting with acute abdominal pain and those with serious chest trauma. Acute abdominal pain is a common reason for seeking emergency medical attention, often requiring prompt intervention, while trauma remains a significant public health concern. This study has particularly concentrated on quality indicators and myocardial injury. 

In terms of quality indicators, we have examined two crucial aspects: the management of pain and the length of stay in the ED. We have identified significant shortcomings in current practices. Firstly, the intensity of pain, a fundamental basis for adequate treatment, is often undocumented, and the time to pain relief is too lengthy. Secondly, patients with acute abdominal pain, who should ideally be hospitalized or discharged after initial diagnostics and treatment, often spend considerably more time in the ED than stipulated in the quality indicators approved by the Health Insurance Fund. This points to deficiencies in the treatment of emergency patients, as a longer ED stay is associated with a poorer prognosis. 

Troponin is a biomarker used to diagnose myocardial infarction. With the introduction of more specific tests, injury can be identified in patients with different profile e.g sepsis, major trauma, shock patients. We found that patients with severe chest trauma, and patients with acute abdominal pain who are not routinely tested for troponin often have occult myocardial injury which is associated with significantly worse outcomes of these patients. 

Watch defense via Teams.