对中等风险胸痛急诊室患者的快速门诊评估可以安全地减少入院
Quentin Reuter1,2, Nicholas Lesh3, Michelle Reyes1,2
1US Acute Care Solutions Canton Ohio USA.
Journal of the American College of Emergency Physicians open
|September 11, 2024
概括
门诊胸痛途径 (OCPP) 安全地管理胸痛患者和4或5的HEART分数,显示与常规护理相比,急性心肌梗塞 (AMI) 和死亡率不低.
科学领域:
- 紧急医疗 紧急医疗
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 胸部疼痛是一种常见的急诊室 (ED) 呈现.
- 风险分层工具,如HEART得分,有助于识别可以安全地作为门诊治疗的患者.
- 评估新的护理途径对于优化ED资源利用和患者结果至关重要.
研究的目的:
- 评估门诊胸痛途径 (OCPP) 的安全性和有效性,用于胸痛患者,心脏评分为4或5.
- 为了比较通过OCPP管理的患者中急性心肌梗塞 (AMI) 和死亡的发生率与历史对照.
- 评估OCPP对ED入学率的影响.
主要方法:
- 追溯性,观察性,非劣等性研究设计.
- 在OCPP (2018) 之前和OCPP (2022) 之后的患者数据的比较.
- 主要结局:AMI和死亡的30天复合率. 通过使用两个单面测试 (TOST) 评估非劣等性.
- 二次结果:ED入学率.
主要成果:
- 在OCPP实施后,HEART分数为4或5的患者的ED入院率从85.1%降至74.1%.
- 通过OCPP出院的患者的30天AMI/死亡率为0.4%,而在OCPP前队列中为2.2%.
- 对OCPP患者的结果与有关AMI/死亡的历史对照无差.
结论:
- 门诊胸痛途径 (OCPP) 是一种安全有效的策略,用于管理ED中选择的胸痛患者.
- OCPP的实施导致了入院率的降低,并保持了HEART分数为4或5的患者的优秀安全概况.
- 与传统管理相比,这种途径在预防心脏不良事件方面显示出非劣势性.
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