In-hospital delay in ST-segment-elevation myocardial infarction after Manchester Triage
Joana Trigo1, Paula Gago, Jorge Mimoso
1Serviço de Cardiologia, Hospital Central de Faro, Faro, Portugal. jotrigo@gmail.com
Insights
The Manchester Triage System (MTS) often misclassifies ST-segment elevation myocardial infarction (STEMI) patients, leading to significant in-hospital delays (IHD) and limiting timely reperfusion therapy.
Area of Science:
- Cardiology
- Emergency Medicine
- Healthcare Systems Analysis
Background:
- Timely reperfusion is critical for ST-segment elevation myocardial infarction (STEMI) patients, directly impacting morbidity and mortality.
- Reducing in-hospital delay (IHD) remains a key objective in STEMI management.
- The effectiveness of the Manchester Triage System (MTS) in expediting STEMI care is under scrutiny.
Purpose of the Study:
- To assess the accuracy of the MTS in classifying STEMI patients.
- To determine the impact of MTS classification on in-hospital delay (IHD) for STEMI patients.
Main Methods:
- A retrospective analysis of 278 STEMI patients admitted to a Coronary Care Unit between January 2005 and November 2006.
- Patients were categorized into two groups based on MTS classification: emergent/very urgent (Group A) and urgent/standard (Group B).
- Comparison of clinical, demographic, pre-hospital delay (PHD), IHD, door-to-needle (DNT), and door-to-balloon (DBT) times between groups.
Main Results:
- No significant differences in clinical characteristics or pre-hospital delay (PHD) were observed between the two MTS classification groups.
- Patients in Group B (urgent/standard classification) experienced significantly longer in-hospital delays (IHD), door-to-needle (DNT), and door-to-balloon (DBT) times.
- A substantial proportion of STEMI patients were not classified as emergent or very urgent by the MTS.
Conclusions:
- The Manchester Triage System (MTS) demonstrated a high rate of suboptimal classification for STEMI patients.
- Incorrect MTS classification was associated with significantly increased in-hospital delays (IHD).
- Suboptimal triage by MTS can impede prompt access to crucial reperfusion therapies for STEMI patients.
Introduction:
In ST-segment elevation myocardial infarction (STEMI), time to reperfusion influences morbidity and mortality, and reducing in-hospital delay (IHD) continues to be important. Doubts have been expressed whether the Manchester Triage System (MTS) contributes to this objective.
Objective:
To evaluate the effectiveness of the MTS in classifying STEMI patients and its effect on IHD.
Methods:
We analyzed 278 patients with STEMI admitted to the Coronary Care Unit through the Emergency Department between January 13 2005 and November 26 2006. The patients were divided into two groups according to their MTS classification: Group A--emergent and very urgent patients; Group B--urgent and standard patients. The two groups were compared in terms of clinical and demographic characteristics, pre-hospital delay (PHD), IHD and door-to-needle (DNT) and door-to-balloon (DBT) times.
Results:
The mean age of the patients studied was 68 +/- 14 years, and 184 patients (65.7%) were male. Group A comprised 220 patients (79%) and Group B 58 patients (21%). There were no significant differences between the two groups in clinical or demographic characteristics or in PHD. IHD, DNT and DBT were significantly longer in Group B.
Conclusions:
1) Although the majority of STEMI patients were classified as emergent or very urgent, the percentage not classified as such by the MTS was excessively high. 2) This could not be explained by clinical characteristics or by PHD. 3) The incorrect classification by the MTS of patients with STEMI resulted in significantly increased IHD in a large proportion of patients, limiting prompt access to reperfusion therapy.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:14Myocarditis III: Medical Management