Comparison between Emergency Severity Index plus Capnometer and Emergency Severity Index in the dyspneic patients with Chronic Heart failure

Q3 Medicine

Evidence Based Care Journal Pub Date : 2021-10-26 DOI:10.22038/EBCJ.2021.59420.2542

Ahmad Talebpour, J. Malekzadeh, S. Mazlom, A. Mirhaghi

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引用次数: 2

Abstract

Background: The Emergency Severity Index (ESI) may not recognize high-risk patients with Heart Failure efficiently.Aim: The goal of this work was to compare the diagnostic validity and mistriage rates of the ESI plus the Capnometer (Capno) and ESI among dyspneic patients with heart failure (HF).Methods: This study was a quasi-experimental group (random assignment) conducted from April 2019 to February 2020. Patients randomly assigned to the ESI+Capno or ESI groups. Triage levels, resources used, disposition and door to ECG and physician visit were compared among patients admitted to the Cardiac Care Unit (CCU), the Cardiac Unit (CU), or discharged from the ED. Interobserver agreement (Kappa) was used to assess reliability of the ESI.Results: Sixty-five HF patients were assigned to the ESI+Capno (n=36) and ESI (n=29) groups. The under-triage rates were 0% and 10%, the over-triage rates were 10% and 31% in the ESI+Capno and ESI groups, respectively. Sensitivity, specificity, accuracy to recognize high-risk HF patients were 100%, 60%, 90% and 62.5%, 42.86%, 48.36% for ESI+Capno and ESI groups, respectively.Implication for Practice: Addition of Capnometer to the ESI increases validity of triage decisions to recognize high-risk HF patients compared to ESI alone. It is recommended that decision to triage HF patients be made after an End-tidal Co2 is considered into decision-making process.

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慢性心力衰竭患者急性呼吸困难指数加Capnometer与急性呼吸困难指数的比较

背景:急诊严重程度指数(ESI)可能不能有效识别高危心力衰竭患者。目的:比较ESI加Capno (Capno)和ESI对呼吸困难合并心力衰竭(HF)患者的诊断有效性和失败率。方法:本研究为准实验组(随机分配)，研究时间为2019年4月至2020年2月。患者随机分为ESI+Capno组或ESI组。分诊水平、使用的资源、处置方式、心电图门和医生就诊情况在入住心脏科(CCU)、心脏科(CU)或从急诊科出院的患者中进行了比较。使用观察者间协议(Kappa)来评估ESI的可靠性。结果:65例HF患者被分为ESI+Capno组(n=36)和ESI组(n=29)。ESI+Capno组和ESI组分诊不足率分别为0%和10%，分诊过高率分别为10%和31%。ESI+Capno组和ESI组识别高危HF患者的敏感性、特异性和准确性分别为100%、60%、90%和62.5%、42.86%、48.36%。实践意义:与ESI相比，在ESI中加入Capnometer增加了识别高风险HF患者的分诊决策的有效性。建议在决策过程中考虑到尾潮Co2后再决定对HF患者进行分类。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Evidence Based Care Journal Medicine-Health Policy

CiteScore

2.00

自引率

0.00%

发文量

审稿时长

12 weeks

期刊介绍： The Evidence Based Care Journal (EBCJ) is an international, peer reviewed, scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of patient care. The primary aim is to promote a high standard of clinically related scholarship which advances and supports patient care in practice. The Journal also aims to promote the international exchange of ideas and experience that draws from the different cultures in which practice takes place. Further, EBCJ seeks to enrich insight into clinical needs and the implications for patient care intervention and models of service delivery. Emphasis is placed on clinical practicality of research findings and strength of study design. EBCJ is essential reading for anyone involved in healthcare professions, whether clinicians, researchers, educators, managers, policy makers, or students. Contributions are welcomed from other health professionals on issues that have a direct impact on patient care.