Triage of patients with acute coronary syndrome at the emergency department: A retrospective study

Brendan McCormack - ORCID: 0000-0001-8525-8905 https://orcid.org/0000-0001-8525-8905Background: Acute coronary syndrome represents a considerable challenge worldwide as one of the causes of death; its diagnosis is often very complex. It includes acute myocardial infarction with ST-segment elevation, acute myocardial infarction without ST-segment elevation, unstable angina pectoris, and sudden cardiac arrest. Methods: This retrospective cohort study included 678 patients who were admitted to the emergency department between 2015 and 2019 with acute coronary syndrome. Triage data were reviewed for vital signs, baseline characteristics, chief complaints, demographic variables, mode and time of arrival, triage, diagnosis, and treatment. Regression was used to identify key symptoms and patient characteristics at triage encounter to predict acute coronary syndrome. Results: A total of 678 triage records were identified. The average age of the sample was 67 years old, 58.6% male, and 31.8% came by themselves to the emergency department. The most common diagnosis was acute myocardial infarctions without ST elevation (38.2%). Chest pain and difficulty in breathing were the two most common symptoms. Most patients were not assigned to the appropriate triage category, i.e., were diagnosed as less urgent. Discussion and conclusion: This study presents the triage of patients with acute coronary syndrome at the emergency department to provide a comprehensive insight into their care. By identifying patient symptoms at the emergency department, nurse triage recognizes patients with acute coronary syndrome on time, thus increasing the accuracy of determining the triage category, which will impact the treatment outcome of patients. ©2023 the author(s), published by De Gruyter. All rights reserved.https://doi.org/10.1515/9783110786088-009pubpu

Treatment of a patient with acute coronary syndrome in the emergency department

Izhodišča: Akutni koronarni sindrom predstavlja velik izziv po celem svetu, saj predstavlja enega od vzrokov umiranja ljudi, njegovo diagnosticiranje pa je velikokrat zahtevno. Delimo ga na akutni miokardni infarkt z dvigom ST spojnice, akutni miokardni infarkt brez dviga ST spojnice, nestabilno angino pektoris in nenadni srčni zastoj. Metode: Pri pisanju teoretičnega dela smo uporabili deskriptivno metodo dela, prav tako pri izvedbi raziskave, kjer smo uporabili tudi kvantitativno metodologijo. V tem drugem delu smo opravili retrospektivno raziskavo, kjer smo pregledali ambulantne kartone pacientov, obravnavanih v izbrani urgentni ambulanti v zadnjih 5 letih. Rezultati: Zabeležili smo 678 pacientov, obravnavanih v urgentni ambulanti, več je bilo moških (58,6 %) in velika večina je bila starejših pacientov. Največ pacientov je z iskanjem pomoči odlašalo nekaj dni. Najpogostejša diagnoza je bil akutni miokardni infarkt brez dviga ST spojnice (26,1 %). Kot najpogostejša simptoma sta se pojavila bolečina v prsnem košu in težko dihanje. Večini pacientom ni bila dodeljena ustrezna triažna kategorija, temveč so bili uvrščeni v nižje kategorije. Večina pacientov je bila napotena v nadaljnjo bolnišnično obravnavo (97,3 %). Diskusija: Z raziskavo smo prikazali obravnavo pacienta z akutnim koronarnim sindromom v urgentni dejavnosti, s katero smo želeli zdravstvenim delavcem omogočiti celosten vpogled v obravnavo teh pacientov. Zaradi vse več pridruženih bolezni, prisotnih dejavnikov tveganja in posledičnega nastanka neznačilnih simptomov je pomembno, da se zdravstveni delavci nenehno izobražujejo, da bodo pacientom lahko nudili pravočasno in kakovostno obravnavo.Introduction: Acute coronary syndrome represents a major challenge worldwide, it is also one of the causes of mortality and its diagnosis is often challenging. We can divide it in a ST-segment elevation acute myocardial infarction, non-ST-segment elevation acute myocardial infarction, an unstable angina pectoris and cardiac arrest. Methods: We used the descriptive method in the theoretical part, also in the research, beside the quantitative methodology. In this second part we have done a retrospective study where we examined the treated patients in the selected emergency department in the last 5 years. Results: We have reported 678 patients treated there, there were more men (58,6 %) than women, also the majority were older patients. The majority of patients delayed with seeking for help with few days. The most common diagnosis at the emergency department was non-ST-elevation acute myocardial infarction (26,1 %). The most common symptoms were chest pain and heavy breathing. Most patients were not assigned the appropriate triage category, but were ranked in lower categories. Most patients (97,3 %) were sent for further treatment and hospitalization. Discussion: The study has shown the treatment of a patient with acute coronary syndrome at the emergency department, with purpose to provide the overview of the treatment of these patients to the medical staff. Due to the increasing number of associated diseases, present risk factors and the resulting atypical symptoms, it is important that medical staff continuously educate themselves in order to provide the quality treatment on time