Among 217 patients with acute myocardial infarction, 53.4% were assigned a lower care priority level, which was associated with atypical symptoms and increased door-to-electrocardiogram times.
Cohort (n=217)
No
What clinical factors influence care priority for myocardial infarction patients using the Manchester Triage System, and how does priority affect time to diagnostic evaluation?
A significant proportion of myocardial infarction patients, including those with STEMI, are misclassified as low priority during triage, leading to delays in initial diagnostic evaluation.
AIMS AND OBJECTIVES: To analyse crucial factors for determining care priority for patients with acute myocardial infarction based on the Manchester Triage System. BACKGROUND: Triage is the first potentially critical step in the care of myocardial infarction patients. However, there are still very few studies on the factors interfering in the lack of care priority for these patients, impacting their treatment and prognosis. DESIGN: Retrospective cohort study with 217 patients in the emergency department of a Brazilian hospital. METHODS: Data were collected from patients' records with a primary diagnosis of myocardial infarction, from March 2014-February 2015. Patients were divided into two groups for statistical analysis: high priority (immediate and very urgent) and low priority (urgent, standard and nonurgent). RESULTS: Most of the patients were male, with a mean age of 62.1 years, with a prevalence of high blood pressure and smoking as risk factors. Lower care priority level was assigned to 116 (53.4%) patients. Sixty-four (29.5%) patients had ST-segment elevation acute myocardial infarction, and 29 (45.3%) of these patients were assigned lower care priority level. Coughing, abdominal pain, onset of symptoms over 24 hr ago and pain of mild to moderate intensity were clinical predictors associated with lower care priority level. Sweating and high blood pressure were associated with high care priority level. Lower care priority level was associated with increased door-to-electrocardiogram and door-to-troponin times. There was no significant difference between the two groups for door-to-needle and door-to-balloon times. CONCLUSIONS: Most of the patients with myocardial infarction were classified as low care priority, showing triage failure either due to symptom variability or need for professional qualification in clinical data collection and interpretation. RELEVANCE TO CLINICAL PRACTICE: The results may support clinical evaluation, bringing chest pain assessment into focus.
Nonnenmacher et al. (2017) conducted a cohort in acute myocardial infarction (n=217). Low care priority level vs. High care priority level was evaluated on Assignment to lower care priority level. Among 217 patients with acute myocardial infarction, 53.4% were assigned a lower care priority level, which was associated with atypical symptoms and increased door-to-electrocardiogram times.