Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania.
University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania.
Res Nurs Health. 2020 Aug;43(4):356-364. doi: 10.1002/nur.22045. Epub 2020 Jun 3.
Emergency department (ED) nurses need to identify patients with potential acute coronary syndrome (ACS) rapidly because treatment delay could impact patient outcomes. Aims of this secondary analysis were to identify key patient factors that could be available at initial ED nurse triage that predict ACS. Consecutive patients with chest pain who called 9-1-1, received a 12-lead electrocardiogram in the prehospital setting, and were transported via emergency medical service were included in the study. A total of 750 patients were recruited. The sample had an average age of 59 years old, was 57% male, and 40% Black. One hundred and fifteen patients were diagnosed with ACS. Older age, non-Caucasian race, and faster respiratory rate were independent predictors of ACS. There was an interaction between heart rate by Type II diabetes receiving insulin in the context of ACS. Type II diabetics requiring insulin for better glycemic control manifested a faster heart rate. By identifying patient factors at ED nurse triage that could be predictive of ACS, accuracy rates of triage may improve, thus impacting patient outcomes.
急诊科（ED）护士需要快速识别出有潜在急性冠状动脉综合征（ACS）的患者，因为治疗延误可能会影响患者的预后。本二次分析的目的是确定在初始 ED 护士分诊时可获得的、预测 ACS 的关键患者因素。本研究纳入了因胸痛拨打 9-1-1、在院前环境中接受 12 导联心电图检查并通过紧急医疗服务转运的连续胸痛患者。共招募了 750 名患者。该样本的平均年龄为 59 岁，57%为男性，40%为黑人。115 名患者被诊断为 ACS。年龄较大、非白种人种族和更快的呼吸频率是 ACS 的独立预测因素。在 ACS 中接受胰岛素治疗的 II 型糖尿病患者的心率存在交互作用。需要胰岛素来更好地控制血糖的 II 型糖尿病患者表现出更快的心率。通过确定 ED 护士分诊时可预测 ACS 的患者因素，分诊的准确率可能会提高，从而影响患者的预后。
