Risk stratification of chest pain patients in the emergency department by a nurse utilizing a point of care protocol.
Eur J Emerg Med
; 15(1): 9-15, 2008 Feb.
Article
in En
| MEDLINE
| ID: mdl-18180660
ABSTRACT
OBJECTIVE:
Risk stratification of patients with ischaemic type chest pain assessed in the emergency department utilizing a point of care (POC) protocol.METHODS:
Patient demographics, cardiac biomarkers, management and follow-up at 6 months were reviewed for patients seen over 20 months.RESULTS:
Out of 546 patients, 351 (64%) were admitted. The diagnoses after admission were confirmed as acute myocardial infarction in 59 patients and unstable angina, (cTroponin T<0.09 ng/ml) in 92 patients. The c-statistic of the receiver operating curves for myocardial infarction (myocardial infarction, cTroponinT at 12 h >0.09 ng/ml) as determined by the POC assay was cTroponin I=0.884, CK-MB=0.883, myoglobin=0.845 and beta-type natriuretic peptide (BNP)=0.755. The c-statistic for the same sample assessed by the hospital laboratory was cTroponin T=0.893 for CK-MB within 12 h of admission it was 0.918; the 12 h cTroponin T was 0.982 and within 24 h of admission NT pro-BNP was 0.789. POC BNP in patients admitted was 68 ng/l (median) vs. 24 ng/l (median) for those not admitted, (P<0.001). POC BNP for patients admitted with unstable angina (12 h cTroponin T <0.09 ng/ml) was 47 ng/l (median, P<0.001). At 6 months, 14 patients had died; five during admission, two within 30 days and seven up to 6 months. During admission two died from heart failure, two with respiratory tract infection and one from carcinoma. Of those not admitted one had died from asbestosis.CONCLUSION:
Risk stratification by a specialist nurse utilizing a POC protocol is an appropriate means of assessing patients with chest pain.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Chest Pain
/
Triage
/
Emergency Nursing
/
Point-of-Care Systems
/
Emergency Service, Hospital
/
Angina, Unstable
/
Myocardial Infarction
Type of study:
Etiology_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Eur J Emerg Med
Journal subject:
MEDICINA DE EMERGENCIA
Year:
2008
Type:
Article
Affiliation country:
United kingdom