急诊室胸痛患者分流和快速出院的安全性和可行性:欧洲心脏病学会 (ESC) 0-1 小时路径与传统 0-3 小时加速诊断方案的非劣效性随机对照试验。

IF 3.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS American heart journal Pub Date : 2024-08-14 DOI:10.1016/j.ahj.2024.08.005
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引用次数: 0

摘要

胸痛患者在急诊科(ED)就诊人数中占很大比例,但只有少数患者(通常为 10%)最终诊断为心肌梗死(MI)。让没有心肌梗死的患者及时出院将缓解急诊科的拥挤状况,提高患者满意度,并降低医院感染的风险,如 Covid 19。美国国家健康与护理优化研究所 (NICE) 建议使用高灵敏度方法测量心肌肌钙蛋白 (cTn),以便对胸痛患者进行快速分类。建议的策略包括入院时和入院后一小时内进行测量(ESC 0-1 小时路径,这是最近获得指南批准的路径,但尚未广泛实施),以及入院时和入院后三小时内进行测量(0-3 小时路径,这是传统的路径,已被广泛采用)。本研究的主要目的有两个:首先,参照更为成熟的 ESC 0-3 小时方案,评估在临床实践中实施 ESC(欧洲心脏病学会)0-1 小时方案的安全性、可行性和影响。主要的结果衡量指标将是ESC 0-1小时方案的安全性。不过,有人担心从样本抽取到结果出来的时间(通常约为 60 分钟)会影响 ESC 0-1 小时路径的可行性。其次,我们的目标是评估床旁分析仪(护理点检测,POCT)在 15 分钟内得出结果是否是实验室检测的可行替代方案。我们将在ESC 0-1小时和0-3小时路径下,将POCT得出的结果与实验室结果进行比较,这是一项随机对照试验中的嵌套对照研究。(Clinicaltrials.gov: NCT05322395)。
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Safety and feasibility of triage and rapid discharge of patients with chest pain from emergency room: A pragmatic, randomized noninferiority control trial of the European Society of Cardiology (ESC) 0 to 1 hour pathway vs conventional 0 to 3 hour accelerated diagnostic protocol
Patients presenting with chest pain represent a significant proportion of Emergency Department (ED) attendances but only a minority, typically 10%, have a final diagnosis of myocardial infarction (MI). Prompt discharge of patients without MI will alleviate ED overcrowding as well as improve patient satisfaction and reduce exposure to risk of hospital acquired infections such as Covid 19.
The measurement of cardiac troponin (cTn) by a high sensitivity method is recommended by the National Institute for health and Care Excellence (NICE) for rapid categorization of patients presenting with chest pain. Strategies proposed include measurement on admission and 1 hour from admission (ESC 0-1-hour pathway, the recent guideline approved pathway which has not been implemented widely), and measurement on admission and 3 hours from admission (0-3-hour pathway, which is conventional and widely adopted).
The primary objective of this study is twofold: firstly, to assess the safety, feasibility, and impact of implementing the ESC (European Society of Cardiology) 0 to 1-hour pathway in clinical practice by reference to the more established ESC 0 to 3-hour protocol. The principal outcome measure will be the safety of the ESC 0 to 1-hour protocol. However, there are concerns that the time from sample draw to result availability (typically around 60 minutes) will impact on the feasibility of the ESC 0 to 1-hour pathway. Secondly, therefore, our goal is to evaluate whether measurement of high sensitivity troponin by a bedside analyzer (point of care testing, POCT), which will produce results in 15 minutes is a feasible alternative to laboratory testing. We will compare the results produced by POCT with the laboratory results in the context of the ESC 0 to 1 hour and 0 to 3-hour pathway, as a nested controlled study in the context of a randomized controlled trial. (clinicaltrials.gov: NCT05322395).
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来源期刊
American heart journal
American heart journal 医学-心血管系统
CiteScore
8.20
自引率
2.10%
发文量
214
审稿时长
38 days
期刊介绍: The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.
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