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

European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine
Andrew J HamiltonJennifer Adgey

Abstract

Risk stratification of patients with ischaemic type chest pain assessed in the emergency department utilizing a point of care (POC) protocol. Patient demographics, cardiac biomarkers, management and follow-up at 6 months were reviewed for patients seen over 20 months. 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 d...Continue Reading

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Citations

Jan 9, 2008·European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine·Patrick K Plunkett
May 1, 2010·Expert Opinion on Medical Diagnostics·D Huckle
Sep 5, 2013·International Journal of Cardiology·Madeleine H E Bruins SlotFrans H Rutten
Feb 1, 2017·Annals of Clinical Biochemistry·Valentina PecoraroTommaso Trenti
Jul 4, 2012·European Journal of Cardiovascular Nursing : Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology·Stephanie TierneyChristi Deaton
Aug 21, 2009·Der Urologe. Ausg. A·P AnheuserJ Steffens
Nov 13, 2008·Expert Review of Molecular Diagnostics·David Huckle

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