What is the clinical evidence from this study?

Study design: Observational. Population: Undifferentiated chest pain and possible acute coronary syndrome. Intervention: Accelerated diagnostic protocol (sensitive cardiac troponin at 2 hours and outpatient exercise stress test). Primary outcome: Major adverse cardiac events by 30 days.

What question did this study set out to answer?

Evaluate the safety, efficiency, and acceptability of implementing an accelerated diagnostic protocol for emergency department patients presenting with undifferentiated chest pain and suspected acute coronary syndrome.

July 21, 2013Emergency Medicine Australasia

Introduction of an accelerated diagnostic protocol in the assessment of emergency department patients with possible acute coronary syndrome: The Nambour Short Low‐Intermediate Chest pain project

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Key result

An accelerated diagnostic protocol using a 2-hour sensitive cardiac troponin test and outpatient stress testing resulted in 0 major adverse cardiac events at 30 days among discharged patients.

Why the study?

Does an accelerated diagnostic protocol safely reduce ED length of stay in emergency department patients with possible acute coronary syndrome?

Population

Emergency department patients with undifferentiated chest pain and possible acute coronary syndrome

Design

Cohort

Follow-up

30 days

Authors

TGTerry GeorgeNambour General Hospital SASarah AshoverQueensland Health LCLouise CullenRoskilde University

Discussion

Member takes

Implication

Supports safety signals for accelerated protocols in low-risk chest pain; leaves open need for RCTs to confirm reduced ED stays.

Key Points

Evaluate the safety, efficiency, and acceptability of implementing an accelerated diagnostic protocol for emergency department patients presenting with undifferentiated chest pain and suspected acute coronary syndrome.
Implemented an accelerated diagnostic protocol over a 7-month period for emergency department patients with undifferentiated chest pain and possible acute coronary syndrome.
Assessed patients using sensitive cardiac troponin testing at baseline and 2 hours post-presentation, discharging suitable patients with outpatient exercise stress testing scheduled.
Nineteen percent of patients with undifferentiated chest pain were safely discharged following normal 2-hour sensitive cardiac troponin results.
Zero major adverse cardiac events occurred within 30 days among discharged patients referred for outpatient exercise stress testing.
Implementation of the accelerated protocol reduced emergency department length of stay while maintaining high patient acceptability.

Study Design

Type

Observational

Structured PICO

Does an accelerated diagnostic protocol safely reduce ED length of stay in emergency department patients with possible acute coronary syndrome?

Population

Emergency department patients with undifferentiated chest pain and possible acute coronary syndrome

Intervention

Accelerated diagnostic protocol (discharge after normal sensitive cardiac troponin taken 2 h after presentation and scheduled to return for outpatient exercise stress test)

Outcome

Major adverse cardiac events by 30 dayshard clinical

An accelerated diagnostic protocol using 2-hour sensitive troponin and outpatient stress testing appears safe for low-intermediate risk chest pain patients, with no 30-day MACE observed in the discharged cohort.

Cite This Study

George et al. (2013) conducted an observational in Undifferentiated chest pain and possible acute coronary syndrome. Accelerated diagnostic protocol (sensitive cardiac troponin at 2 hours and outpatient exercise stress test) was evaluated on Major adverse cardiac events by 30 days. An accelerated diagnostic protocol using a 2-hour sensitive cardiac troponin test and outpatient stress testing resulted in 0 major adverse cardiac events at 30 days among discharged patients.

synapsesocial.com/papers/6a0f4b76b6f5ee04015f9feb https://doi.org/10.1111/1742-6723.12091

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Introduction of an accelerated diagnostic protocol in the assessment of emergency department patients with possible acute coronary syndrome: The Nambour Short Low‐Intermediate Chest pain project

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Introduction of an accelerated diagnostic protocol in the assessment of emergency department patients with possible acute coronary syndrome: The Nambour Short Low‐Intermediate Chest pain project

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Also Consider