Cedric Lefebvre

Learn More
BACKGROUND The HEART Pathway is a decision aid designed to identify emergency department patients with acute chest pain for early discharge. No randomized trials have compared the HEART Pathway with usual care. METHODS AND RESULTS Adult emergency department patients with symptoms related to acute coronary syndrome without ST-elevation on ECG (n=282) were(More)
OBJECTIVES This study sought to compare the direct cost of medical care and clinical events during the first year after patients with intermediate risk acute chest pain were randomized to stress cardiac magnetic resonance (CMR) observation unit (OU) testing versus inpatient care. BACKGROUND In a recent study, randomization to OU-CMR reduced median index(More)
BACKGROUND Among intermediate- to high-risk patients with chest pain, we have shown that a cardiac magnetic resonance (CMR) stress test strategy implemented in an observation unit (OU) reduces 1-year health care costs compared with inpatient care. In this study, we compare 2 OU strategies to determine among lower-risk patients if a mandatory CMR stress test(More)
BACKGROUND Lower-extremity subcutaneous emphysema is an unusual presentation in the emergency department, and it is often associated with gas-forming bacterial infections that confer significant morbidity and mortality. Because the presence of subcutaneous emphysema in an extremity can be alarming, physicians often pursue aggressive diagnostic and(More)
BACKGROUND The Emergency Department Assessment of Chest pain Score-Accelerated Diagnostic Protocol (EDACS-ADP) is a decision aid designed to safely identify emergency department (ED) patients with chest pain for early discharge. Derivation and validation studies in Australasia have demonstrated high sensitivity (99%-100%) for major adverse cardiac events(More)
BACKGROUND The 2-hour accelerated diagnostic protocol (ADAPT) and the history electrocardiogram age risk factors troponin (HEART) Pathway are decision aids designed to identify Emergency Department (ED) patients with chest pain who are safe for early discharge. Both have demonstrated high sensitivity (>99%) for major adverse cardiac events (MACE) at 30 days(More)
OBJECTIVES Accelerated diagnostic protocols (ADPs), such as the HEART Pathway, are gaining popularity in emergency departments (EDs) as tools used to risk stratify patients with acute chest pain. However, provider nonadherence may threaten the safety and effectiveness of ADPs. The objective of this study was to determine the frequency and impact of ADP(More)
Prompt and accurate identification of patients with acute coronary syndrome (ACS) presenting to the emergency department (ED) is paramount to the success of interventional and therapeutic strategies. Accurate diagnosis of ST-segment elevation myocardial infarction or non-ST-segment elevation myocardial infarction is hindered by atypical presentations and(More)
BACKGROUND Faculty involvement in resident teaching events is beneficial to resident education, yet evidence about the factors that promote faculty attendance at resident didactic conferences is limited. OBJECTIVE To determine whether offering continuing medical education (CME) credits would result in an increase in faculty attendance at weekly emergency(More)
STUDY OBJECTIVE We determine whether imaging with cardiac magnetic resonance imaging (MRI) in an observation unit would reduce medical costs among patients with emergent non-low-risk chest pain who otherwise would be managed with an inpatient care strategy. METHODS Emergency department patients (n=110) at intermediate or high probability for acute(More)