Application Of Accelerated Diagnostic Protocols In Stratifying Emergency Department Patients With Chest Pain Combined With Point-of-care Testing

Objective: To compare the ability of TRUST accelerated diagnostic protocol,EDACS accelerated diagnostic protocol,and Vancouver chest pain rule combined with point-of-care testing,in rapid assessment of patients with chest pain suspecting acute coronary syndrome and in identifying low-risk patients for early,safe emergency department discharge.Data and Method: Patients with chest pain suggestive of ACS were recruited if they were aged 18 years and older during January 2017 to February 2017 in emergency department of Tianjin Medical University General Hospital.Data recorded included: the patient's sex,age,medical history,risk factors,chest pain symptoms,physical examination results,0-h and 2-h electrocardiogram,0-h five indicators of cardiopulmonary function and hs-cTnI result,2-h levels of MYO & cTnI and CK-MB,6-h hs-cTnI result,to stratify patients into various risk groups with TRUST accelerated diagnostic protocol,EDACS accelerated diagnostic protocol,Vancouver chest pain rule,the five indicators of cardiopulmonary function as only risk stratification tool and the TRUST-ADP using MYO & cTnI &CK-MB as biochemical markers tool.The end point was acute myocardial infarction within 30 days.Data were analyzed using IBM SPSS.Results: A total of 134 patients were enrolled.Of the patients 57/134(42.5%)in the TRUST-ADP had a low risk for suitable discharge and 1/57 had AMI within 30 days;the sensitivity of stratifying low-risk patient was 83.3%,the specificity was 43.8%,and the negative predictive value was 98.2%.Of the patients 51/134(38.1%)in the EDACS-ADP had a low risk for suitable for discharge and 0/51 had AMI within 30 days;the sensitivity of stratifying low risk patient was 100%,the specificity was 39.8%,and the negative predictive value was 100%.Of the patients 24/134(17.9%)in the Vancouver chest pain rule had a low risk for suitable for discharge and 0/24 had AMI within 30 days;the sensitivity of stratifying low risk patient was 100%,the specificity was 18.8%,and the negative predictive value was 100%.Of the patients 39/134(29.1%)in the ADP using with the five indicators of cardiopulmonary function as only risk stratification tool had a low risk for suitable for discharge and 2/39 had AMI within 30 days;the sensitivity of stratifying low risk patient was 66.7%,the specificity was 28.9%,and the negative predictive value was 94.9%.Of the patients 73/134(54.5%)in the TRUST-ADP using MYO & cTnI &CK-MB as biochemical markers had a low risk for suitable discharge and 1/73 had AMI within 30 days;the sensitivity of stratifying low risk patient was 83.3%,the specificity was 56.3%,and the negative predictive value was 98.6%.Conclusion: Using accelerated diagnostic protocols combined with point-of-care testing to stratify emergency department patients with chest pain is possible.The advantage of the TRUST accelerated diagnostic protocol is that more than 30% of the emergency chest pain patients can be allowed to immediately discharge after a single blood draw,but the sensitivity < 98% and the specificity < 99.5%.The Vancouver chest pain rule had a 2-h stay for suitable for discharge and the percentage of low risk patients < 30%,but the sensitivity ? 98% and the specificity? 99.5%.Only the EDACS-ADP meet the intended target,stratified > 30% of low-risk patient,with a sensitivity ? 98% and a specificity ? 99.5%.The POCT can enhance the implementation of ADP.But using POCT as only risk stratification tool had a low sensitivity and negative predictive value in stratifying low risk patient.