Journal article
Beyond triage: the diagnostic accuracy of emergency department nursing staff risk assessment in patients with suspected acute coronary syndromes
Emergency Medicine Journal, Vol.33, pp.99-104
2016
Abstract
Objectives To establish the accuracy of emergency department (ED) nursing staff risk assessment using an established chest pain risk score alone and when incorporated with presentation high-sensitivity troponin testing as part of an accelerated diagnostic protocol (ADP). Design Prospective observational study comparing nursing and physician risk assessment using the modified Goldman (m-Goldman) score and a predefined ADP, incorporating presentation high-sensitivity troponin. Setting A UK District ED. Patients Consecutive patients, aged ≥18, with suspected cardiac chest pain and non-ischaemic ECG, for whom the treating physician determined serial troponin testing was required. Outcome measures 30-day major adverse cardiac events (MACE). Results 960 participants were recruited. 912/960 (95.0%) had m-Goldman scores recorded by physicians and 745/960 (77.6%) by nursing staff. The area under the curve of the m-Goldman score in predicting 30-day MACE was 0.647 (95% CI 0.594 to 0.700) for physicians and 0.572 (95% CI 0.510 to 0.634) for nursing staff (p=0.09). When incorporated into an ADP, sensitivity for the rule-out of MACE was 99.2% (95% CI 94.8% to 100%) and 96.7% (90.3% to 99.2%) for physicians and nurses, respectively. One patient in the physician group (0.3%) and three patients (1.1%) in the nursing group were classified as low risk yet had MACE. There was fair agreement in the identification of low-risk patients (kappa 0.31, 95% CI 0.24 to 0.38). Conclusions The diagnostic accuracy of ED nursing staff risk assessment is similar to that of ED physicians and interobserver reliability between assessor groups is fair. When incorporating high-sensitivity troponin testing, a nurse-led ADP has a miss rate of 1.1% for MACE at 30 days.
Details
- Title
- Beyond triage: the diagnostic accuracy of emergency department nursing staff risk assessment in patients with suspected acute coronary syndromes
- Authors
- Edward Watts Carlton (Author) - Bournemouth University, United KingdomAhmed Khattab (Author) - Bournemouth University, United KingdomKim Greaves (Author) - University of the Sunshine Coast
- Publication details
- Emergency Medicine Journal, Vol.33, pp.99-104
- Publisher
- B M J Group
- Date published
- 2016
- DOI
- 10.1136/emermed-2015-204780
- ISSN
- 1472-0205
- Copyright note
- Copyright © 2006 The Author. The author accepted version of the paper is reproduced here for non-commercial purposes only in accordance with the copyright policy of the publisher.
- Organisation Unit
- Faculty of Science, Health, Education and Engineering; University of the Sunshine Coast, Queensland
- Language
- English
- Record Identifier
- 99449124602621
- Output Type
- Journal article
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