Aleem Khand MD , James Hatherley MBChB , Ahmed Dakshi MBBCh , Guy Miller BMBS , Lisa Bailey PhD , Michael Fisher MD, PhD , Christopher Goulden MBBS , Zaid Noori MBCHB , Anju Rawat MSc , Rachel Hornby BSC (hons) , Hannah Fearon MSC , Nirmol Meah MBBS , Sarah Davies MChem , Katarzyna Sekulska BAN , Awtad Hassan BSC , Angela Lambert BSC , Suzannah Phillips PhD , Ray Raj MRSEd , Tom Wiles MBChB , Paul Collinson MD
{"title":"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。","authors":"Aleem Khand MD , James Hatherley MBChB , Ahmed Dakshi MBBCh , Guy Miller BMBS , Lisa Bailey PhD , Michael Fisher MD, PhD , Christopher Goulden MBBS , Zaid Noori MBCHB , Anju Rawat MSc , Rachel Hornby BSC (hons) , Hannah Fearon MSC , Nirmol Meah MBBS , Sarah Davies MChem , Katarzyna Sekulska BAN , Awtad Hassan BSC , Angela Lambert BSC , Suzannah Phillips PhD , Ray Raj MRSEd , Tom Wiles MBChB , Paul Collinson MD","doi":"10.1016/j.ahj.2024.08.005","DOIUrl":null,"url":null,"abstract":"<div><div>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.</div><div>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 <strong>0-1-hour pathway</strong>, the recent guideline approved pathway which has not been implemented widely), and measurement on admission and 3 hours from admission (<strong>0-3-hour pathway</strong>, which is conventional and widely adopted).</div><div>The <strong>primary objective</strong> 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: <strong>NCT05322395).</strong></div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"278 ","pages":"Pages 235-247"},"PeriodicalIF":3.7000,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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\",\"authors\":\"Aleem Khand MD , James Hatherley MBChB , Ahmed Dakshi MBBCh , Guy Miller BMBS , Lisa Bailey PhD , Michael Fisher MD, PhD , Christopher Goulden MBBS , Zaid Noori MBCHB , Anju Rawat MSc , Rachel Hornby BSC (hons) , Hannah Fearon MSC , Nirmol Meah MBBS , Sarah Davies MChem , Katarzyna Sekulska BAN , Awtad Hassan BSC , Angela Lambert BSC , Suzannah Phillips PhD , Ray Raj MRSEd , Tom Wiles MBChB , Paul Collinson MD\",\"doi\":\"10.1016/j.ahj.2024.08.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><div>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.</div><div>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 <strong>0-1-hour pathway</strong>, the recent guideline approved pathway which has not been implemented widely), and measurement on admission and 3 hours from admission (<strong>0-3-hour pathway</strong>, which is conventional and widely adopted).</div><div>The <strong>primary objective</strong> 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: <strong>NCT05322395).</strong></div></div>\",\"PeriodicalId\":7868,\"journal\":{\"name\":\"American heart journal\",\"volume\":\"278 \",\"pages\":\"Pages 235-247\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2024-08-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American heart journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0002870324001996\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American heart journal","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0002870324001996","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
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).
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.