利用 Hs-cTnT 和风险分层路径改进急诊科胸痛评估

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
Zhengqiu Zhou MD , Kevin S. Hsu MD , Joshua Eason DO , Brian Kauh MD , Joshua Duchesne MD , Mikiyas Desta MD , William Cranford MS , Alison Woodworth PhD , James D. Moore MD , Seth T. Stearley MD , Vedant A. Gupta MD
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引用次数: 0

摘要

背景胸痛是全球急诊科(ED)最常见的就诊原因之一。我们的研究旨在评估利用第五代高敏心肌肌钙蛋白 T 检测法(Hs-cTnT)和 HEART 评分(病史、心电图、年龄、危险因素、肌钙蛋白)对非创伤性胸痛患者进行评估的新型风险分层方法在减少急诊科资源利用率方面的效果。方法在实施结合 hs-cTnT 和 HEART 评分的新型风险分层路径前后 6 个月,对一家大型学术性四级医疗急诊室的非创伤性胸痛成人患者的评估进行了回顾性病历审查。主要结果是急诊室住院时间(LOS);次要结果包括心脏病咨询率、入院率、急诊室登门人数和私自出院患者人数。实施路径后,急诊室总住院时间中位数从 317 分钟降至 286 分钟,绝对值减少了 31 分钟(95% 置信区间为 22-41 分钟)(p < 0.001)。此外,心脏科会诊率从 26.9% 降至 16.0%(p <0.0001),入院率从 30.1% 降至 22.7%(p <0.0001),急诊室住院人数占所有非创伤性胸痛患者的比例从实施前的 25.结论在评估非创伤性胸痛患者时,我们的新型胸痛路径改善了许多急诊室吞吐量指标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Improvement of Emergency Department Chest Pain Evaluation Using Hs-cTnT and a Risk Stratification Pathway

Background

Chest pain is among the most common reasons for presentation to the emergency department (ED) worldwide. Additional studies on most cost-effective ways of differentiating serious vs. benign causes of chest pain are needed.

Objectives

Our study aimed to evaluate the effectiveness of a novel risk stratification pathway utilizing 5th generation high-sensitivity cardiac troponin T assay (Hs-cTnT) and HEART score (History, Electrocardiogram, Age, Risk factors, Troponin) in assessing nontraumatic chest pain patients in reducing ED resource utilization.

Methods

A retrospective chart review was performed 6 months prior to and after the implementation of a novel risk stratification pathway that combined hs-cTnT with HEART score to guide evaluation of adult patients presenting with nontraumatic chest pain at a large academic quaternary care ED. Primary outcome was ED length of stay (LOS); secondary outcomes included cardiology consult rates, admission rates, number of ED boarders, and number of eloped patients.

Results

A total of 1707 patients and 1529 patients were included pre- and postimplementation, respectively. Median overall ED LOS decreased from 317 to 286 min, an absolute reduction of 31 min (95% confidence interval 22–41 min), after pathway implementation (p < 0.001). Furthermore, cardiology consult rate decreased from 26.9% to 16.0% (p < 0.0001), rate of admission decreased from 30.1% to 22.7% (p < 0.0001), and number of ED boarders as a proportion of all nontraumatic chest pain patients decreased from 25.13% preimplementation to 18.63% postimplementation (p < 0.0001).

Conclusions

Implementation of our novel chest pain pathway improved numerous ED throughput metrics in the evaluation of nontraumatic chest pain patients.

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来源期刊
Journal of Emergency Medicine
Journal of Emergency Medicine 医学-急救医学
CiteScore
2.40
自引率
6.70%
发文量
339
审稿时长
2-4 weeks
期刊介绍: The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine
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