Department of Nursing, The Faculty of Health and Welfare Sciences, University of Haifa, Haifa, Israel; Rambam Health Care Campus, Haifa, Israel.
Rambam Health Care Campus, Haifa, Israel.
Int Emerg Nurs. 2020 May;50:100855. doi: 10.1016/j.ienj.2020.100855. Epub 2020 Mar 31.
To explore the role of family history (FH) as a risk factor for ST elevation myocardial infarction (STEMI) in the emergency department (ED) setting during nurse triage and to analyze the clinical outcomes and time lags of patients with and without FH of coronary artery disease (CAD).
A retrospective archive study was conducted in 2017 in a public tertiary ED at an academic teaching hospital. Data were collected from the electronic medical record for the period of January 2015 to December 2016 on STEMI patients. Of the 335 patients identified with STEMI we included 140 (41.8%) who were eligible to the study inclusion criteria and treated at the ED. Patients transferred directly to the catheterization lab were excluded. We collected and compared information from nurse and physician records on known risk factors for STEMI in adherence to American Heart Association guidelines and hospital outcomes between patients with and without FH of CAD. Logistic regressions were performed to identify the contribution of each risk factor on hospital outcomes.
A negligible number of triage nurses documented if the patient had a FH compared to physicians (5.7% vs. 98.8%). Patients with and without FH of CAD were similarly evaluated at ED triage. However, patients with FH transferred earlier to the catheterization lab and had lower hospital readmission rates. Logistic regression analysis showed that FH is a protective factor for ED revisit for general and cardiac reasons.
There is a need to retrieve information on FH of CAD for all patients presenting with symptoms suggestive of STEMI at ED triage.
探讨在急诊科分诊中，家族史（FH）作为 ST 段抬高型心肌梗死（STEMI）的危险因素的作用，并分析有和无 FH 的冠心病（CAD）患者的临床结局和时间延迟。
这是一项 2017 年在一所学术教学医院的公立三级急诊科进行的回顾性档案研究。研究期间为 2015 年 1 月至 2016 年 12 月，从电子病历中收集 STEMI 患者的数据。在 335 名确诊为 STEMI 的患者中，我们纳入了 140 名（41.8%）符合研究纳入标准并在急诊科接受治疗的患者。排除直接转至导管室的患者。我们收集并比较了护士和医生记录中关于 STEMI 的已知危险因素的信息，这些信息符合美国心脏协会的指南和医院的结局，比较了有和无 FH 的 CAD 患者之间的信息。进行逻辑回归分析，以确定每个危险因素对医院结局的贡献。
与医生相比，分诊护士记录患者 FH 的比例微不足道（5.7% vs. 98.8%）。有和无 FH 的 CAD 患者在急诊科分诊时得到了相似的评估。然而，有 FH 的患者更早地转至导管室，且医院再入院率较低。逻辑回归分析表明，FH 是 ED 因一般和心脏原因复诊的保护因素。
有必要在急诊科分诊时为所有出现 STEMI 症状的患者检索 FH 的 CAD 信息。
