Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan.
Am J Emerg Med. 2021 Oct;48:165-169. doi: 10.1016/j.ajem.2021.04.029. Epub 2021 Apr 14.
Coronary risk scores (CRS) including History, Electrocardiogram, Age, Risk Factors, Troponin (HEART) score and Emergency Department Assessment of Chest pain Score (EDACS) can help identify patients at low risk of major adverse cardiac events. In the emergency department (ED), there are wide variations in hospital admission rates among patients with chest pain.
This study aimed to evaluate the impact of CRS on the disposition of patients with symptoms suggestive of acute coronary syndrome in the ED.
This retrospective cohort study included 3660 adult patients who presented to the ED with chest pain between January and July in 2019. Study inclusion criteria were age > 18 years and a primary position International Statistical Classification of Diseases and Related Health Problems-10th revision coded diagnosis of angina pectoris (I20.0-I20.9) or chronic ischemic heart disease (I25.0-I25.9) by the treating ED physician. If the treating ED physician completed the electronic structured variables for CRS calculation to assist disposition planning, then the patient would be classified as the CRS group; otherwise, the patient was included in the control group.
Among the 2676 patients, 746 were classified into the CRS group, whereas the other 1930 were classified into the control group. There was no significant difference in sex, age, initial vital signs, and ED length of stay between the two groups. The coronary risk factors were similar between the two groups, except for a higher incidence of smokers in the CRS group (19.6% vs. 16.1%, p = 0.031). Compared with the control group, significantly more patients were discharged (70.1% vs. 64.6%) directly from the ED, while fewer patients who were hospitalized (25.9% vs. 29.7%) or against-advise discharge (AAD) (2.6% vs. 4.0%) in the CRS group. Major adverse cardiac events and mortality at 60 days between the two groups were not significantly different.
A higher ED discharge rate of the group using CRS may indicate that ED physicians have more confidence in discharging low-risk patients based on CRS.
包括病史、心电图、年龄、危险因素、肌钙蛋白（HEART）评分和急诊科胸痛评分（EDACS）在内的冠状动脉风险评分（CRS）有助于识别发生重大不良心脏事件风险较低的患者。在急诊科（ED），胸痛患者的住院率存在很大差异。
本研究旨在评估 CRS 对 ED 中疑似急性冠状动脉综合征患者处置的影响。
这是一项回顾性队列研究，纳入了 2019 年 1 月至 7 月期间因胸痛就诊于 ED 的 3660 名成年患者。研究纳入标准为年龄＞18 岁，且由 ED 医生对患者进行初次治疗时，其国际疾病分类第 10 次修订版（ICD-10）的主要位置编码诊断为心绞痛（I20.0-I20.9）或慢性缺血性心脏病（I25.0-I25.9）。如果 ED 医生完成了 CRS 计算的电子结构化变量以辅助处置计划，那么该患者将被归类为 CRS 组；否则，该患者将被归入对照组。
在 2676 名患者中，746 名患者被归类为 CRS 组，而另外 1930 名患者被归类为对照组。两组患者的性别、年龄、初始生命体征和 ED 住院时间均无显著差异。两组患者的冠状动脉危险因素相似，除 CRS 组的吸烟者比例较高（19.6% vs. 16.1%，p = 0.031）。与对照组相比，CRS 组中直接从 ED 出院的患者比例显著更高（70.1% vs. 64.6%），而住院患者比例较低（25.9% vs. 29.7%）和 AAD 比例较低（2.6% vs. 4.0%）。两组患者 60 天内的重大不良心脏事件和死亡率无显著差异。
使用 CRS 的患者 ED 出院率较高，可能表明 ED 医生根据 CRS 对低危患者的出院更有信心。
