Group of Study and Research on Nursing Care for Adults and Older Adults (GEPECADI-CNPq), Porto Alegre, RS, Brazil.
School of Nursing, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
J Clin Nurs. 2018 Mar;27(5-6):e940-e950. doi: 10.1111/jocn.14011. Epub 2018 Jan 8.
To analyse crucial factors for determining care priority for patients with acute myocardial infarction based on the Manchester Triage System.
Triage is the first potentially critical step in the care of myocardial infarction patients. However, there are still very few studies on the factors interfering in the lack of care priority for these patients, impacting their treatment and prognosis.
Retrospective cohort study with 217 patients in the emergency department of a Brazilian hospital.
Data were collected from patients' records with a primary diagnosis of myocardial infarction, from March 2014-February 2015. Patients were divided into two groups for statistical analysis: high priority (immediate and very urgent) and low priority (urgent, standard and nonurgent).
Most of the patients were male, with a mean age of 62.1 years, with a prevalence of high blood pressure and smoking as risk factors. Lower care priority level was assigned to 116 (53.4%) patients. Sixty-four (29.5%) patients had ST-segment elevation acute myocardial infarction, and 29 (45.3%) of these patients were assigned lower care priority level. Coughing, abdominal pain, onset of symptoms over 24 hr ago and pain of mild to moderate intensity were clinical predictors associated with lower care priority level. Sweating and high blood pressure were associated with high care priority level. Lower care priority level was associated with increased door-to-electrocardiogram and door-to-troponin times. There was no significant difference between the two groups for door-to-needle and door-to-balloon times.
Most of the patients with myocardial infarction were classified as low care priority, showing triage failure either due to symptom variability or need for professional qualification in clinical data collection and interpretation.
The results may support clinical evaluation, bringing chest pain assessment into focus.
基于曼彻斯特分诊系统，分析确定急性心肌梗死患者护理优先级的关键因素。
分诊是心肌梗死患者护理的第一个潜在关键步骤。然而，关于干扰这些患者护理优先级不足的因素，以及这些因素如何影响他们的治疗和预后的研究仍然很少。
巴西一家医院急诊科的 217 例患者的回顾性队列研究。
从 2014 年 3 月至 2015 年 2 月期间有心肌梗死初步诊断的患者病历中收集数据。将患者分为两组进行统计分析：高优先级（立即和非常紧急）和低优先级（紧急、标准和非紧急）。
大多数患者为男性，平均年龄为 62.1 岁，高血压和吸烟等危险因素较为常见。116 例（53.4%）患者的护理优先级较低。64 例（29.5%）患者患有 ST 段抬高型急性心肌梗死，其中 29 例（45.3%）患者的护理优先级较低。咳嗽、腹痛、症状出现超过 24 小时和疼痛程度为轻至中度是与较低护理优先级相关的临床预测因素。出汗和高血压与高护理优先级相关。较低的护理优先级与门到心电图和门到肌钙蛋白时间的延长有关。两组之间的门到针和门到球囊时间没有显著差异。
大多数心肌梗死患者被归类为低护理优先级，这表明分诊失败要么是由于症状的可变性，要么是由于需要专业资格进行临床数据收集和解释。
研究结果可能支持临床评估，重点关注胸痛评估。
