Dataset Information

Development of acute chest pain services in the UK.

ABSTRACT:

Background

In 2001, a survey of emergency departments in the UK showed wide variation in the management of acute undifferentiated chest pain. There has since been substantial development of chest pain services and research into chest pain units (CPUs).

Aim

To determine whether practice had changed in 2006.

Methods

All emergency departments in the UK were surveyed by postal questionnaire to the lead clinician or first named consultant.

Results

Responses were received from 192 of 253 (76%) departments. 25 (10%) stated they had a CPU, although 8 (32%) of these were set up in trials. Many CPUs provided care that was similar to that provided by hospitals without a CPU, with 76% using 10-12 h troponin and 29% only providing delayed access to exercise tolerance testing (up to 2-3 weeks after attendance). Over all departments, the proportion with access to exercise testing had more than doubled between 2001 and 2006, from 21% to 49% (94/190), although only a minority (16%) were able to provide this immediately or within the next working day. Use of departmental guidelines for patients with chest pain had increased from 42% to 72% of departments. Use of troponins increased from 52% to 96%, whereas use of creatine kinase MB decreased from 54% to 31% of departments. Availability of short-stay facilities had more than doubled from 21% to 59%.

Conclusions

Formal development of CPUs has been limited and mostly restricted to trials. However, there has been substantial informal and ad hoc development of acute chest pain services. Development of chest pain services in the UK is progressing in a disorganised way.

SUBMITTER: Cross E

PROVIDER: S-EPMC2658179 | biostudies-literature | 2007 Feb

REPOSITORIES: biostudies-literature

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Publications

Development of acute chest pain services in the UK.

Cross Elizabeth E How Steven S Goodacre Steve S

Emergency medicine journal : EMJ 20070201 2

<h4>Background</h4>In 2001, a survey of emergency departments in the UK showed wide variation in the management of acute undifferentiated chest pain. There has since been substantial development of chest pain services and research into chest pain units (CPUs).<h4>Aim</h4>To determine whether practice had changed in 2006.<h4>Methods</h4>All emergency departments in the UK were surveyed by postal questionnaire to the lead clinician or first named consultant.<h4>Results</h4>Responses were received ...[more]

PMID: 17251613

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Project description:ObjectiveTo systematically appraise the available evidence to determine the accuracy of decision aids for emergency medical services (EMS) telephone triage of patients with chest pain suspected to be caused by acute coronary syndrome (ACS) or life-threatening conditions.DesignSystematic review.Data sourcesElectronic searches were performed in Embase 1974, Medline 1946 and CINAHL 1937 databases from 3 March 2020 to 4 March 2020.Eligibility criteriaThe review included all types of original studies that included adult patients (>18 years) who called EMS with a primary complaint of chest pain and evaluated dispatch triage priority by telephone. Outcomes of interest were a final diagnosis of ACS, acute myocardial infarction or other life-threatening conditions.Data extraction and synthesisTwo authors independently extracted data on study design, population, study period, outcome and all data for assessment of accuracy, including cross-tabulation of triage priority against the outcomes of interest. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 assessment tool.ResultsSearches identified 553 papers, of which 3 were eligible for inclusion. Those reports described the evaluation of three different prediction models with variation in the variables used to detect ACS. The overall results showed that dispatch triage tools have good sensitivity to detect ACS and life-threatening conditions, even though they are used to triage signs and symptoms rather than diagnosing the patients. On the other hand, prediction models were built to detect ACS and life-threatening conditions, and therefore, prediction models showed better sensitivity and negative predictive value than dispatch triage tools.ConclusionWe have identified three prediction models for telephone triage of patients with chest pain. While they have been found to have greater accuracy than standard EMS dispatch systems, prospective external validation is essential before clinical use is considered.Prospero registration numberThis systematic review was pre-registered on the International prospective register of systematic reviews (PROSPERO) database (reference CRD42020171184).

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Project description:BackgroundThe History Electrocardiogram Age Risk factor Troponin (HEART) Pathway and Emergency Department Assessment of Chest pain Score (EDACS) are validated accelerated diagnostic pathways designed to risk stratify patients presenting to the emergency department with chest pain. Data from large multisite prospective studies comparing these accelerated diagnostic pathways are limited.MethodsThe HEART Pathway Implementation is a prospective three-site cohort study, which accrued adults with symptoms concerning for acute coronary syndrome. Physicians completed electronic health record HEART Pathway and EDACS risk assessments on participants. Major adverse cardiac events (death, myocardial infarction and coronary revascularisation) at 30 days were determined using electronic health record, insurance claims and death index data. Test characteristics for detection of major adverse cardiac events were calculated for both accelerated diagnostic pathways and McNemar's tests were used for comparisons.Results5799 patients presenting to the emergency department were accrued, of which HEART Pathway and EDACS assessments were completed on 4399. Major adverse cardiac events at 30 days occurred in 449/4399 (10.2%). The HEART Pathway identified 38.4% (95% CI 37.0% to 39.9%) of patients as low-risk compared with 58.1% (95% CI 56.6% to 59.6%) identified as low-risk by EDACS (p<0.001). Major adverse cardiac events occurred in 0.4% (95% CI 0.2% to 0.9%) of patients classified as low-risk by the HEART Pathway compared with 1.0% (95% CI 0.7% to 1.5%) of patients identified as low-risk by EDACS (p<0.001). Thus, the HEART Pathway had a negative predictive value of 99.6% (95% CI 99.1% to 99.8%) for major adverse cardiac events compared with a negative predictive value of 99.0% (95% CI 98.5% to 99.3%) for EDACS.ConclusionsEDACS identifies a larger proportion of patients as low-risk than the HEART Pathway, but has a higher missed major adverse cardiac events rate at 30 days. Physicians will need to consider their risk tolerance when deciding whether to adopt the HEART Pathway or EDACS accelerated diagnostic pathway.Trial registration numberNCT02056964.

Dataset Information

Development of acute chest pain services in the UK.

Background

Aim

Methods

Results

Conclusions

Publications

Development of acute chest pain services in the UK.

Similar Datasets

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