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Factors that influence care priority for chest pain patients using the manchester triage system
Carine Lais Nonnenmacher1, Ananda Ughini Bertoldo Pires1,2, Vítor Monteiro Moraes1,2
1Group of Study and Research on Nursing Care for Adults and Older Adults (GEPECADI-CNPq), Porto Alegre, RS, Brazil.
Insights
Many acute myocardial infarction patients receive low care priority, indicating triage failure. Factors like symptom variability and clinical assessment impact treatment urgency and prognosis.
Area of Science:
- Emergency Medicine
- Cardiology
Background:
- Triage is a critical first step for acute myocardial infarction (AMI) patients.
- Limited research exists on factors affecting AMI patient care priority.
- Suboptimal triage impacts patient treatment and prognosis.
Purpose of the Study:
- To analyze key factors influencing care priority determination for AMI patients.
- To evaluate the effectiveness of the Manchester Triage System in AMI cases.
Main Methods:
- Retrospective cohort study of 217 AMI patients in a Brazilian emergency department.
- Data collected from March 2014 to February 2015.
- Patients categorized into high (immediate, very urgent) and low (urgent, standard, nonurgent) priority groups.
Main Results:
- Over half (53.4%) of AMI patients were assigned a low care priority level.
- Clinical predictors for lower priority included cough, abdominal pain, symptom onset >24 hours, and mild/moderate pain.
- Sweating and hypertension were associated with high care priority.
- Lower priority correlated with longer door-to-ECG and door-to-troponin times.
Conclusions:
- A significant proportion of AMI patients are undertriaged, suggesting system failures.
- Variability in symptoms and clinical interpretation challenges contribute to triage errors.
- Focusing on chest pain assessment and improving clinical data interpretation is crucial.
Aims And Objectives:
To analyse crucial factors for determining care priority for patients with acute myocardial infarction based on the Manchester Triage System.
Background:
Triage is the first potentially critical step in the care of myocardial infarction patients. However, there are still very few studies on the factors interfering in the lack of care priority for these patients, impacting their treatment and prognosis.
Design:
Retrospective cohort study with 217 patients in the emergency department of a Brazilian hospital.
Methods:
Data were collected from patients' records with a primary diagnosis of myocardial infarction, from March 2014-February 2015. Patients were divided into two groups for statistical analysis: high priority (immediate and very urgent) and low priority (urgent, standard and nonurgent).
Results:
Most of the patients were male, with a mean age of 62.1 years, with a prevalence of high blood pressure and smoking as risk factors. Lower care priority level was assigned to 116 (53.4%) patients. Sixty-four (29.5%) patients had ST-segment elevation acute myocardial infarction, and 29 (45.3%) of these patients were assigned lower care priority level. Coughing, abdominal pain, onset of symptoms over 24 hr ago and pain of mild to moderate intensity were clinical predictors associated with lower care priority level. Sweating and high blood pressure were associated with high care priority level. Lower care priority level was associated with increased door-to-electrocardiogram and door-to-troponin times. There was no significant difference between the two groups for door-to-needle and door-to-balloon times.
Conclusions:
Most of the patients with myocardial infarction were classified as low care priority, showing triage failure either due to symptom variability or need for professional qualification in clinical data collection and interpretation.
Relevance To Clinical Practice:
The results may support clinical evaluation, bringing chest pain assessment into focus.
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