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Utility of B-Type Natriuretic Peptide Testing in the Emergency Department—Reply

Utility of B-Type Natriuretic Peptide Testing in the Emergency Department—Reply In reply We fully agree with Costantino and colleagues that differences in baseline characteristics may confound the results of a randomized controlled trial. Therefore, it is important to stress that the detailed description of demographic variables, symptoms, physical examination, vital signs, and laboratory analyses clearly showed that the BNP group and the control group were well matched in the B-Type Natriuretic Peptide for Acute Shortness of Breath Evaluation (BASEL) study.1,2 Therefore, it is appropriate to conclude from the BASEL data that BNP testing is cost-effective in patients with acute dyspnea. Costantino and colleagues argue that additional baseline variables including arterial blood gases and number of breaths per minute could have revealed a significantly different level of clinical severity. However, as suggested by the similarities in all other baseline characteristics, arterial blood gases and number of breaths per minute were also comparable in the BNP group and the control group in the BASEL study: PaO2, 9.3 vs 9.3 kPa (P = .99); PaCO2, 5.6 vs 5.5 kPa (P = .67); pH, 7.4 vs 7.4 (P = .74); and 24 vs 23 breaths per minute (P = .39). We disagree with Costantino and colleagues that exclusion of those patients admitted to the intensive care unit would provide valid insights. Intensive care unit admission of patients presenting with acute dyspnea to the emergency department is a result of initial disease severity and the response to initial therapy. This aspect is particularly evident when considering that about 40% of patients admitted to the intensive care unit were admitted after several days of therapy in a regular ward. Correspondence: Dr Mueller, Department of Internal Medicine, University Hospital, Petersgraben 4, CH-4031 Basel, Switzerland (chmueller@uhbs.ch). References 1. Mueller CScholer ALaule Kilian K et al. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med 2004;350647- 654PubMedGoogle ScholarCrossref 2. Mueller CLaule-Kilian KSchindler C et al. Cost-effectiveness of B-type natriuretic peptide testing in patients with acute dyspnea. Arch Intern Med 2006;1661081- 1087PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Utility of B-Type Natriuretic Peptide Testing in the Emergency Department—Reply

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Publisher
American Medical Association
Copyright
Copyright © 2006 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.166.20.2288-a
Publisher site
See Article on Publisher Site

Abstract

In reply We fully agree with Costantino and colleagues that differences in baseline characteristics may confound the results of a randomized controlled trial. Therefore, it is important to stress that the detailed description of demographic variables, symptoms, physical examination, vital signs, and laboratory analyses clearly showed that the BNP group and the control group were well matched in the B-Type Natriuretic Peptide for Acute Shortness of Breath Evaluation (BASEL) study.1,2 Therefore, it is appropriate to conclude from the BASEL data that BNP testing is cost-effective in patients with acute dyspnea. Costantino and colleagues argue that additional baseline variables including arterial blood gases and number of breaths per minute could have revealed a significantly different level of clinical severity. However, as suggested by the similarities in all other baseline characteristics, arterial blood gases and number of breaths per minute were also comparable in the BNP group and the control group in the BASEL study: PaO2, 9.3 vs 9.3 kPa (P = .99); PaCO2, 5.6 vs 5.5 kPa (P = .67); pH, 7.4 vs 7.4 (P = .74); and 24 vs 23 breaths per minute (P = .39). We disagree with Costantino and colleagues that exclusion of those patients admitted to the intensive care unit would provide valid insights. Intensive care unit admission of patients presenting with acute dyspnea to the emergency department is a result of initial disease severity and the response to initial therapy. This aspect is particularly evident when considering that about 40% of patients admitted to the intensive care unit were admitted after several days of therapy in a regular ward. Correspondence: Dr Mueller, Department of Internal Medicine, University Hospital, Petersgraben 4, CH-4031 Basel, Switzerland (chmueller@uhbs.ch). References 1. Mueller CScholer ALaule Kilian K et al. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med 2004;350647- 654PubMedGoogle ScholarCrossref 2. Mueller CLaule-Kilian KSchindler C et al. Cost-effectiveness of B-type natriuretic peptide testing in patients with acute dyspnea. Arch Intern Med 2006;1661081- 1087PubMedGoogle ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 13, 2006

Keywords: brain natriuretic peptide,emergency service, hospital

References