163 Outcome of integration of new centaur (Siemen’s) high-sensitivity troponin I assay with heart score chest pain pathway to maximise early discharge from Emergency Department (ED)
| Autor: | Jerry J Murphy, Ei Mon Thet, Jenifer Crilley |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Acute coronary syndrome Unstable angina business.industry Emergency department 030204 cardiovascular system & hematology medicine.disease Chest pain 03 medical and health sciences 0302 clinical medicine Internal medicine Troponin I medicine Cardiology cardiovascular diseases 030212 general & internal medicine medicine.symptom business Early discharge TIMI Mace |
| Zdroj: | Acute Coronary Syndromes. |
| DOI: | 10.1136/heartjnl-2019-bcs.160 |
| Popis: | Introduction Chest pain is a common presentation to the ED. Differentiating those with an Acute Coronary Syndrome from the majority without, within 4 hours, is a priority. Introduction of high-sensitivity Troponin I (hsTnI) assays has the potential to allow early discharge from ED but at the expense of lower specificity. Given the pressure in ED to identify patients who can safely be discharged we developed an algorithm based on the HEART score. This combines the history, ECG, age, risk factors and hsTnI level and outperforms TIMI and GRACE scores in identifying low-risk patients. Patients with a score of ≥4 have an increased major adverse cardiac event (MACE) rate at 30 days; those with a score of Methods An initial algorithm based on the HEART score tool was developed incorporating estimated hsTnI boundaries for the CENTAUR assay to inform the “T” component of the tool. This was tested on a 2 month sample of patients presenting with chest pain to the ED. Following review a revised pathway was developed. Please see the figure. Patient outcome was recorded with both pathways including subsequent investigations and MACE at 30 days and compared with historical discharge rates for chest pain from the same ED. Sensitivity, specificity and NPV were calculated. Results There were 478 presentations with chest pain and at least one hsTnI level. Age ranged from 13 to 98 years (median 56); 50% were male. There were 21 (4%) MACE within 30 days of the initial presentation (NSTEMI: 18, STEMI: 1, unstable angina requiring CABG: 1, acute pulmonary oedema: 1). A 2 hour hsTnI ≤8 identified a low-risk group with no MACE Conclusion The CENTAUR hs-TnI assay and HEART score with modifications would facilitate the early discharge of patients with chest pain from ED within 4 hours without missing any MACE at 30 days. Conflict of Interest This is part of the finding of my thesis for MSc which will need to be completed in September 2019. |
| Databáze: | OpenAIRE |
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