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January 13, 2021Open Access

A modified chief complaint-based cardiac triage strategy for reducing delays in the management of patients with ST-elevation myocardial infarction

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Key result

A chief complaint-based cardiac triage strategy significantly reduced median door-to-ECG time from 5 to 4 minutes and increased the achievement rate of door-to-ECG time <10 minutes from 78.9% to 95.0%.

Why the study?

Timely performing electrocardiography is crucial for early detection of STEMI, prompting the need for strategies to shorten door-to-ECG time.

Does a chief complaint-based cardiac triage strategy reduce door-to-ECG and door-to-balloon times in patients with STEMI?

Population

117 ED patients with STEMI at a single tertiary referral center

Comparison

Post-intervention chief complaint-based cardiac triage protocol vs pre-intervention care

Design

Retrospective before-and-after single-center study

Authors

HSHung-Yuan SuJTJen-Long TsaiYHYin-Chou Hsu

Discussion

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Overview

Chief complaint-based triage was associated with shorter door-to-ECG times in this STEMI cohort; leaves open need for randomized trials before practice change.

Study Design

Type

Cohort (n=117)

Multicenter

No

Structured PICO

Does a chief complaint-based cardiac triage strategy reduce door-to-ECG and door-to-balloon times in patients with STEMI?

P
Population
117 adult patients (mean age 62.3 years, 12.8% female) diagnosed with STEMI in the emergency department who received primary PCI, evaluated before and after implementation of a cardiac triage strategy.
I
Intervention
A chief complaint-based 'cardiac triage' protocol comprising raising alert among medical staff with bedside red triage tags and immediate bedside ECG after focused history-taking.
C
Comparator
Standard pre-intervention management using a five-level triage system without specific cardiac triage designation.
O
Outcome
Median door-to-ECG (DTE) time and the achievement rate of DTE time < 10 minutes.surrogate

Main Result

Absolute Event Rate: 4% vs 5%

p-value: p=0.02

A modified chief complaint-based cardiac triage strategy significantly reduced door-to-ECG and door-to-balloon times for STEMI patients in the emergency department.

Limitations

  • Relatively small number of patients due to single-center nature
  • Feasibility and effectiveness in other ED settings remain to be validated
  • Accuracy of data acquisition may be hampered by ambiguous symptom descriptions in medical records
  • Small sample size due to single-center nature

Cite This Study

Su et al. (2021) conducted a cohort in ST-elevation myocardial infarction (n=117). Chief complaint-based cardiac triage protocol vs. Standard five-level triage system was evaluated on Median door-to-ECG time (minutes) (p=0.02). A chief complaint-based cardiac triage strategy significantly reduced median door-to-ECG time from 5 to 4 minutes and increased the achievement rate of door-to-ECG time <10 minutes from 78.9% to 95.0%.

synapsesocial.com/papers/6a20d2b910699ec7be2a982fhttps://doi.org/10.21203/rs.3.rs-141934/v1
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients2015 · 53 citations
  2. 2Quality improvement in the door‐to‐balloon times for ST‐elevation myocardial infarction patients presenting without chest pain2011 · 17 citations
  3. 3Reperfusion times for ST elevation myocardial infarction: a prospective audit2020 · 15 citations
  4. 4Optimization of Door-to-electrocardiogram Time Within a Critical Pathway for the Management of Acute Coronary Syndromes at a Teaching Hospital in Colombia2015 · 6 citations
  5. 5Strategies for Reducing the Door-to-Balloon Time in Acute Myocardial Infarction2006 · 845 citations