Key result
Triage ECG and point-of-care troponin screening linked to ~651% more ACS diagnoses vs usual care.
Why the study?
ACS is underdiagnosed in sub-Saharan Africa, and triage-based interventions that improved care in high-income settings had not been evaluated in sub-Saharan African EDs.
Does a triage-based screening protocol improve the diagnosis and treatment of acute coronary syndrome in adults presenting to a sub-Saharan African emergency department with chest pain or shortness of breath?
Observational (n=1,020)
No
Does a triage-based screening protocol improve the diagnosis and treatment of acute coronary syndrome in adults presenting to a sub-Saharan African emergency department with chest pain or shortness of breath?
Effect estimate: OR 7.51 (95% CI 3.52-19.7)
Absolute Event Rate: 12.2% vs 1.8%
p-value: p=<0.001
Implementation of a triage-based ECG and troponin screening protocol in a Tanzanian emergency department significantly increased the diagnosis of ACS and the administration of aspirin.
May increase ACS detection with ECG-troponin triage in sub-Saharan EDs; leaves open effects on outcomes.
Background Evidence suggests that acute coronary syndrome (ACS) is underdiagnosed in sub‐Saharan Africa. Triage‐based interventions have improved ACS diagnosis and management in high‐income settings but have not been evaluated in sub‐Saharan African emergency departments (EDs). Our objective was to estimate the effect of a triage‐based screening protocol on ACS diagnosis and care in a Tanzanian ED. Methods and Results All adults presenting to a Tanzanian ED with chest pain or shortness of breath were prospectively enrolled. Treatments and clinician‐documented diagnoses were observed and recorded. In the preintervention phase (August 2018 through January 2019), ACS testing and treatment were dictated by physician discretion, as per usual care. A triage‐based protocol was then introduced, and in the postintervention phase (January 2019 through October 2019), research assistants performed ECG and point‐of‐care troponin I testing on all patients with chest pain or shortness of breath upon ED arrival. Pre‐post analyses compared ACS care between phases. Of 1020 total participants (339 preintervention phase, 681 postintervention phase), mean (SD) age was 58.9 (19.4) years. Six (1.8%) preintervention participants were diagnosed with ACS, versus 83 (12.2%) postintervention participants (odds ratio [OR], 7.51; 95% CI, 3.52–19.7; P <0.001). Among all participants, 3 (0.9%) preintervention participants received aspirin, compared with 50 (7.3%) postintervention participants (OR, 8.45; 95% CI, 3.07–36.13; P <0.001). Conclusions Introduction of a triage‐based ACS screening protocol in a Tanzanian ED was associated with significant increases in ACS diagnoses and aspirin administration. Additional research is needed to determine the effect of ED‐based interventions on ACS care and clinical end points in sub‐Saharan Africa.
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Hertz et al. (2020) conducted an observational in Acute Coronary Syndrome (n=1,020). Triage-based screening protocol (ECG and point-of-care troponin I testing) vs. Usual care (physician discretion) was evaluated on ACS diagnosis (OR 7.51, 95% CI 3.52-19.7, p=<0.001). A triage-based screening protocol using ECG and point-of-care troponin significantly increased ACS diagnoses compared to usual care (12.2% vs 1.8%; OR 7.51; 95% CI 3.52-19.7; P<0.001).
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