A 2 hour diagnostic protocol to assess patients with chest pain symptoms

January 01, 0001

A 2 hour diagnostic protocol to assess patients with chest pain symptoms

The researchers from New Zealand, Australia, Singapore, the USA, China, India, Indonesia, South Korea, Thailand and Chinese Taipei aimed to prospectively validate the safety of a predefined 2 hour accelerated diagnostic protocol (ADP) to assess patients presenting to the emergency department with chest pain symptoms suggestive of acute coronary syndrome. This observational study was undertaken in 14 emergency departments in nine countries in the Asia-Pacific region, in patients aged 18 years and older with at least 5 min of chest pain. The ADP included use of a structured pre-test probability scoring method (Thrombolysis in Myocardial Infarction, TIMI, score), electrocardiograph, and point-of-care biomarker panel of troponin, creatine kinase MB, and myoglobin. 3582 consecutive patients were recruited and completed 30-day follow-up.

11.8% patients had a major adverse cardiac event. The ADP classified 9.8% patients as low risk and potentially suitable for early discharge. A major adverse cardiac event occurred in 0·9% of these patients, giving the ADP a sensitivity of 99.3%, a negative predictive value of 99.1%, and a specificity of 11.0%.

The researchers concluded: "This novel ADP identifies patients at very low risk of a short-term major adverse cardiac event who might be suitable for early discharge. Such an approach could be used to decrease the overall observation periods and admissions for chest pain. The components needed for the implementation of this strategy are widely available. The ADP has the potential to affect health-service delivery worldwide."

This may help improve guidelines and lessens costs and the clogging of A & E departments.

For the full abstract, click here.

The Lancet 377(9771):1077-1084, 26 March 2011
© 2011 Elsevier Limited
A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study. Martin Than, Louise Cullen, Christopher M Reid. Correspondence to Martin Than: [email protected]

Category: K. Circulatory, HSR. Health Services Research. Keywords: diagnostic protocol, assessment, chest pain, prospective observational validation study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 19 April 2011

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