Risk stratification of chest pain patients in the emergency department by a nurse utilizing a point of care protocol.

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.

• Authors: Andrew J Hamilton, Leslie A Swales, Johanne Neill, John C Murphy, Karen M Darragh, Laurence G Rocke, Jennifer Adgey
• Journal: European journal of emergency medicine : official journal of the European Society for Emergency Medicine (Eur J Emerg Med) Vol. 15 Issue 1 Pg. 9-15 (Feb 2008) ISSN: 0969-9546 [Print] England
• PMID: 18180660 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Troponin I
• Troponin T
• Natriuretic Peptide, Brain

Topics

• Adult
• Aged
• Angina, Unstable (complications, diagnosis)
• Biomarkers (blood)
• Chest Pain (etiology)
• Emergency Nursing
• Emergency Service, Hospital
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (complications, diagnosis)
• Natriuretic Peptide, Brain (blood)
• Nurses
• Point-of-Care Systems
• ROC Curve
• Retrospective Studies
• Triage (methods)
• Troponin I (blood)
• Troponin T (blood)