Arslanian-Engoren Cynthia
University of Michigan School of Nursing, Ann Arbor, MI 48109, USA.
J Cardiovasc Nurs. 2004 Jul-Aug;19(4):280-6. doi: 10.1097/00005082-200407000-00008.
Coronary heart disease is the number 1 killer of adults in the United States, affecting 1 in 5 men and women. However, women are more likely than men to die after an acute coronary event and are less likely to receive prompt or aggressive treatment. Few studies have examined the role of emergency nurses' triage decisions in these disparities, even though nurses often determine initial patient priority and urgency status for emergency cardiac evaluation and treatment. The purpose of this prospective study was to examine if nurses' initial triage decisions could predict admission or discharge diagnoses for acute coronary syndromes (ACS). A total of 108 nurses' triage decisions made by 13 nurses were examined. There were no differences in nurses' triage decisions based on patient gender, race, or age. By multivariate analysis, chest pain, history of coronary heart disease, history of myocardial infarction, and smoking were predictive of an ACS decision. Overall, accuracy for predicting admission diagnosis was poor. Sensitivity and specificity were 57% and 59%, respectively, with a positive predictive value of 68% and a negative predictive value of 56%. It was similarly poor for predicting discharge diagnosis. Sensitivity and specificity for discharge diagnosis were 55% and 69%, respectively, with a positive predictive value of 17% and a negative predictive value of 93%. Findings indicate limitations in the ability of nurses' triage decisions to predict admission and discharge diagnoses for ACS.
冠心病是美国成年人的头号杀手，每5名男性和女性中就有1人受其影响。然而，女性在急性冠状动脉事件后死亡的可能性比男性更高，而且接受及时或积极治疗的可能性更小。尽管护士通常会确定患者接受紧急心脏评估和治疗的初始优先级和紧急状态，但很少有研究探讨急诊护士的分诊决策在这些差异中所起的作用。这项前瞻性研究的目的是检验护士的初始分诊决策是否能够预测急性冠状动脉综合征（ACS）的入院或出院诊断。研究共检查了13名护士做出的108项分诊决策。护士的分诊决策在患者性别、种族或年龄方面没有差异。通过多变量分析，胸痛、冠心病史、心肌梗死史和吸烟是ACS决策的预测因素。总体而言，预测入院诊断的准确性较差。敏感性和特异性分别为57%和59%，阳性预测值为68%，阴性预测值为56%。预测出院诊断的情况同样不佳。出院诊断的敏感性和特异性分别为55%和69%，阳性预测值为17%，阴性预测值为93%。研究结果表明，护士的分诊决策在预测ACS入院和出院诊断方面存在局限性。
