急诊科胸痛患者分诊中自我报告的急诊严重程度评估量表（EDACS）与医生报告的EDACS的比较。
Comparison of self-reported EDACS versus physician-reported EDACS for the triage of chest pain patients in the emergency department.
作者信息
Ng Mingwei, Liu Zhenghong, Tan Jean Su Ling, Ponampalam R
机构信息
Department of Emergency Medicine Singapore General Hospital Singapore.
出版信息
J Am Coll Emerg Physicians Open. 2021 Mar 2;2(2):e12393. doi: 10.1002/emp2.12393. eCollection 2021 Apr.
OBJECTIVES
Currently, there are no guidelines to help triage nurses identify high-risk emergency department chest pain patients. Patient self-reporting of Emergency Department Assessment of Chest Pain Score (EDACS) could facilitate more reliable triage compared to nursing gestalt, but this novel concept is untested. This study hypothesizes that because EDACS requires minimal clinical gestalt to derive, self-reported EDACS (S-EDACS) at triage is likely to correlate well with traditional physician-reported EDACS (P-EDACS) and have potential application as a triage tool.
METHODS
This single-center pilot prospective cohort study analyzed 60 patients who completed a self-reported questionnaire upon triage to determine their S-EDACS. This was matched against P-EDACS, derived from an identical questionnaire completed by the blinded treating physician. Secondary endpoint of major adverse cardiovascular events (MACE) within 30 days (all-cause mortality, myocardial infarction, coronary revascularization) was assessed by 2 blinded emergency physicians who independently reviewed the electronic medical records. S/P-EDACS also were benchmarked against nursing gestalt (based on triage to low/high-acuity areas) and emergency physician gestalt (disposition and admitting/discharge diagnoses).
RESULTS
There was perfect agreement between S/P-EDACS in this study ( = 1.00). Fifteen patients (25.0%) had minor discordances in their absolute S/P-EDACS that did not affect risk stratification. Of these, 11/15 (73.3%) had higher S-EDACS, suggesting S-EDACS is more likely to safely overcall MACE risk. S-EDACS outperformed nursing gestalt, triaging a greater proportion of patients (71.7% vs 35.0%) as low risk without compromising patient safety, and demonstrated similar accuracy as emergency physician gestalt.
CONCLUSION
S-EDACS strongly correlates with P-EDACS with perfect agreement and has potential to be used as a triage tool.
目的
目前，尚无指南可帮助分诊护士识别急诊科胸痛高危患者。与护士的整体判断相比，患者自我报告的急诊科胸痛评估评分（EDACS）可能有助于进行更可靠的分诊，但这一新颖概念尚未经过验证。本研究假设，由于EDACS只需极少的临床整体判断即可得出，因此分诊时自我报告的EDACS（S-EDACS）可能与传统医生报告的EDACS（P-EDACS）具有良好的相关性，并有可能作为一种分诊工具应用。
方法
这项单中心前瞻性队列试验研究分析了60例患者，这些患者在分诊时完成了一份自我报告问卷，以确定其S-EDACS。将其与P-EDACS进行匹配，P-EDACS来自由不知情的主治医生填写的相同问卷。30天内主要不良心血管事件（MACE，全因死亡率、心肌梗死、冠状动脉血运重建）的次要终点由2名不知情的急诊医生独立审查电子病历进行评估。S/P-EDACS还与护士的整体判断（基于分诊到低/高急症区域）和急诊医生的整体判断（处置及入院/出院诊断）进行了对比。
结果
本研究中S/P-EDACS之间完全一致（κ=1.00）。15例患者（25.0%）的绝对S/P-EDACS存在轻微差异，但不影响风险分层。其中，11/15（73.3%）的S-EDACS较高，表明S-EDACS更有可能安全地高估MACE风险。S-EDACS优于护士的整体判断，在不影响患者安全的情况下，将更大比例的患者分诊为低风险（71.7%对35.0%），并且与急诊医生的整体判断准确性相似。
结论
S-EDACS与P-EDACS高度相关，完全一致，有潜力用作分诊工具。
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