Identifying Low‐risk Patients for Early Discharge From Emergency Department Without Using Subjective Descriptions of Chest Pain: Insights From Providing Rapid Out of Hospital Acute Cardiovascular Treatment (<scp>PROACT</scp>) 3 and 4 Trials

Sepehrvand, Nariman; Zheng, Yinggan; Armstrong, Paul W.; Welsh, Robert C.

doi:10.1111/acem.13183

Cited by 2 publications

(2 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These times varied according to gender, age groups and ACS type. Appropriate identification of patients with symptoms of chest pain and early discharge as recommendations should be improved [ 21 – 24 ]. We explained the increasing duration between chest pain onset and emergency arrival with increasing age by the emergence of social loneliness of the elderly in Tunisia [ 11 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Management of acute coronary syndrome in emergency departments: a cross sectional multicenter study (Tunisia)

et al. 2018

View full text Add to dashboard Cite

BackgroundWe aimed to describe diagnosed acute coronary syndrome (ACS) and its care management and outcomes in emergency departments (EDs) and to determine related cardiovascular risk factors (CVRFs).MethodsWe conducted a cross sectional multicenter study that included 1173 adults admitted to EDs for acute chest pain (ACP) in 2015 at 14 sites in Tunisia. Data included patients’ baseline characteristics, diagnosis, treatment and output.ResultsACS represented 49.7% of non-traumatic chest pain [95% CI: 46.7–52.6]; 74.2% of ACS cases were unstable angina/non-ST-segment-elevation myocardial infarction (UA/NSTEMI). Males represented 67.4% of patients with ACS (p < 0.001). The median age was 60 years (IQR 52–70). Emergency medical service transportation was used in 11.9% of cases. The median duration between chest pain onset and ED arrival was two hours (Inter quartile ranges (IQR) 2–4 h). The age-standardized prevalence rate was 69.9/100,000 PY; the rate was 96.24 in men and 43.7 in women. In the multivariable analysis, CVRFs related to ST segment elevation myocardial infarction were age correlated to sex and active smoking. CVRFs related to UA/NSTEMI were age correlated to sex, familial and personal vascular history and type 2 diabetes. We reported 27 cases of major adverse cardiovascular events (20.0%) in patients with STEMI and 36 in patients with UA/NSTEMI (9.1%).ConclusionHalf of the patients consulting EDs with ACP had ACS. Emergency medical service transportation calls were rare. Management delays were acceptable. The risk of developing an UA/NSTEMI was equal to the number of CVRFs + 1. To improve patient outcomes, it is necessary to increase adherence to international management guidelines.

show abstract

Section: Discussionmentioning

confidence: 99%

Management of acute coronary syndrome in emergency departments: a cross sectional multicenter study (Tunisia)

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Further, IMPACT does not emphasise chest pain characteristics; comparable scores, including the Emergency Department Assessment of Chest Pain Score (EDACS), incorporate subjective features with low diagnostic value and possibly cause ascertainment bias 1 , 7 . Patients at low risk can be identified without pain descriptors 8 …”

mentioning

confidence: 99%

Less is more: chest pain pathways in clinical care

Christiansen

2017

Medical Journal of Australia

View full text Add to dashboard Cite

Identifying Low‐risk Patients for Early Discharge From Emergency Department Without Using Subjective Descriptions of Chest Pain: Insights From Providing Rapid Out of Hospital Acute Cardiovascular Treatment (PROACT) 3 and 4 Trials

Abstract: The diagnostic protocols performed well without their chest pain characteristics component. Further studies are suggested to explore the performance of ADPs when these simplified ADPs are combined with high-sensitive troponin assays.

Cited by 2 publications

References 41 publications

Management of acute coronary syndrome in emergency departments: a cross sectional multicenter study (Tunisia)

Management of acute coronary syndrome in emergency departments: a cross sectional multicenter study (Tunisia)

Less is more: chest pain pathways in clinical care

Contact Info

Product

Resources

About