Davis Leslie L, McCoy Thomas P, Riegel Barbara, McKinley Sharon, Doering Lynn V, Dracup Kathleen, Moser Debra K
Leslie L. Davis, PhD, RN, ANP-BC, FAANP, FAHA, is an assistant professor of nursing at the School of Nursing, University of North Carolina, Greensboro. She conducts research related to the behavioral aspects of cardiovascular symptom management in women. Thomas P. McCoy, PhD, PStat, is a statistician and clinical associate professor at the School of Nursing, University of North Carolina, Greensboro. Barbara Riegel, PhD, RN, FAHA, FAAN, is the edith clemmer steinbright professor of Gerontology at the University of Pennsylvania School of Nursing. Dr. Riegel is an established nurse scientist studying adults with cardiovascular disease. Her primary research interest is self-care of older adults with chronic heart failure. Sharon McKinley, PhD, RN, is from Deakin University, Victoria, Australia. Her research interests include delay in response to ACS symptoms and sleep in critically ill patients. Lynn V. Doering, RN, PhD, FAAN, is from the University of California, Los Angeles. She is a professor and associate dean in Academic and Student Affairs, UCLA School of Nursing. Kathleen Dracup, RN, FNP, PhD, FAAN, is a dean emerita and professor emerita at the University of California, San Francisco. Debra K. Moser, PhD, RN, FAAN, is from the University of Kentucky, Lexington, and University of Ulster, Newtownabbey, UK. She is a professor and Linda C. Gill Chair of Cardiovascular Nursing, where she conducts research related to self-care among individuals with or at risk for cardiac disease and heart failure.
Dimens Crit Care Nurs. 2016 Nov/Dec;35(6):332-338. doi: 10.1097/DCC.0000000000000207.
Past research has shown discrepancies between the time of symptom onset for patients with acute coronary syndrome (ACS) as documented in the medical record (MR) and patients' recall of the time assessed through subject interviews done later by researchers.
The aim of this study is to determine if there were differences between the time of symptom onset documented in the MR and subject interview taking into consideration sex, age group, and recall period for patients admitted to the emergency department for symptoms suggestive of ACS.
A secondary analysis was conducted on data from the PROMOTION (Patient Response to Myocardial Infarction Following a Teaching Intervention Offered by Nurses) trial, a multicenter randomized clinical trial to reduce patient prehospital delay to treatment in ACS.
Of the 3522 subjects with CAD enrolled into the trial, 3087 subjects completed 2-year follow-up. Of these, 331 subjects sought treatment in the emergency department for ACS symptoms and 276 patients (83%) had complete information on the time of symptom onset from both sources. Of the 276 patients, 25 (9%) had differing times more than 48 hours and were thus excluded. The median difference between the 2 sources was 45.0 minutes. When both times were examined, there were no significant differences in time by sex (P = .720) or by age group (P = .188). The median number of days between the interview and the date of symptom onset was 29.5 days. There was a significant correlation between differences in the time of symptom onset and the length of recall period (rs = 0.148, P = .023). In multivariable modeling, a longer recall period was associated with greater median differences in the symptom onset time (b = 13.2, P = .023).
These results suggest that the time of symptom onset obtained at the time of the index event and documented in the MR is not interchangeable with data obtained later by research staff, especially if the interview is not conducted near the time of the index event.
既往研究表明，急性冠状动脉综合征（ACS）患者病历（MR）中记录的症状发作时间与研究人员随后通过受试者访谈评估的患者回忆时间存在差异。
本研究的目的是确定在考虑到因疑似ACS症状而入住急诊科患者的性别、年龄组和回忆期的情况下，MR中记录的症状发作时间与受试者访谈时间之间是否存在差异。
对PROMOTION（护士提供教学干预后患者对心肌梗死的反应）试验的数据进行了二次分析，该试验是一项多中心随机临床试验，旨在减少ACS患者的院前治疗延迟。
在纳入试验的3522名CAD受试者中，3087名受试者完成了2年随访。其中，331名受试者因ACS症状在急诊科寻求治疗，276名患者（83%）从两个来源获得了关于症状发作时间的完整信息。在这276名患者中，25名（9%）的时间差异超过48小时，因此被排除。两个来源之间的中位差异为45.0分钟。当检查两个时间时，按性别（P = 0.720）或年龄组（P = 0.188）划分的时间没有显著差异。访谈与症状发作日期之间的中位天数为29.5天。症状发作时间差异与回忆期长度之间存在显著相关性（rs = 0.148，P = 0.023）。在多变量建模中，较长的回忆期与症状发作时间的较大中位差异相关（b = 13.2，P = 0.023）。
这些结果表明，在索引事件发生时获得并记录在MR中的症状发作时间与研究人员后来获得的数据不可互换，特别是如果访谈不是在索引事件发生时附近进行的。
