PMID- 28743479
DCOM- 20181119
LR  - 20181119
IS  - 1532-8171 (Electronic)
IS  - 0735-6757 (Linking)
VI  - 36
IP  - 2
DP  - 2018 Feb
TI  - Integrating heart rate variability, vital signs, electrocardiogram, and troponin 
      to triage chest pain patients in the ED.
PG  - 185-192
LID - S0735-6757(17)30583-1 [pii]
LID - 10.1016/j.ajem.2017.07.054 [doi]
AB  - BACKGROUND: Current triage methods for chest pain patients typically utilize
      symptoms, electrocardiogram (ECG), and vital sign data, requiring interpretation 
      by dedicated triage clinicians. In contrast, we aimed to create a quickly
      obtainable model integrating the objective parameters of heart rate variability
      (HRV), troponin, ECG, and vital signs to improve accuracy and efficiency of
      triage for chest pain patients in the emergency department (ED). METHODS: Adult
      patients presenting to the ED with chest pain from September 2010 to July 2015
      were conveniently recruited. The primary outcome was a composite of
      revascularization, death, cardiac arrest, cardiogenic shock, or lethal arrhythmia
      within 72-h of presentation to the ED. To create the chest pain triage (CPT)
      model, logistic regression was done where potential covariates comprised of vital
      signs, ECG parameters, troponin, and HRV measures. Current triage methods at our 
      institution and modified early warning score (MEWS) were used as comparators.
      RESULTS: A total of 797 patients were included for final analysis of which 146
      patients (18.3%) met the primary outcome. Patients were an average age of 60years
      old, 68% male, and 56% triaged to the most acute category. The model consisted of
      five parameters: pain score, ST-elevation, ST-depression, detrended fluctuation
      analysis (DFA) alpha1, and troponin. CPT model>0.09, CPT model>0.15, current
      triage methods, and MEWS>/=2 had sensitivities of 86%, 74%, 75%, and 23%,
      respectively, and specificities of 45%, 71%, 48%, and 78%, respectively.
      CONCLUSION: The CPT model may improve current clinical triage protocols for chest
      pain patients in the ED.
CI  - Copyright (c) 2017 Elsevier Inc. All rights reserved.
FAU - Sakamoto, Jeffrey Tadashi
AU  - Sakamoto JT
AD  - Duke University School of Medicine, Durham, NC, United States.
FAU - Liu, Nan
AU  - Liu N
AD  - Health Services Research Centre, Singapore Health Services, Singapore; Centre for
      Quantitative Medicine, Duke-NUS Medical School, Singapore. Electronic address:
FAU - Koh, Zhi Xiong
AU  - Koh ZX
AD  - Department of Emergency Medicine, Singapore General Hospital, Singapore.
FAU - Guo, Dagang
AU  - Guo D
AD  - Department of Emergency Medicine, Singapore General Hospital, Singapore.
FAU - Heldeweg, Micah Liam Arthur
AU  - Heldeweg MLA
AD  - Faculty of Medical Sciences, University of Groningen, Netherlands.
FAU - Ng, Janson Cheng Ji
AU  - Ng JCJ
AD  - Department of Emergency Medicine, Singapore General Hospital, Singapore.
FAU - Ong, Marcus Eng Hock
AU  - Ong MEH
AD  - Department of Emergency Medicine, Singapore General Hospital, Singapore; Health
      Services and Systems Research, Duke-NUS Medical School, Singapore.
LA  - eng
PT  - Journal Article
DEP - 20170717
PL  - United States
TA  - Am J Emerg Med
JT  - The American journal of emergency medicine
JID - 8309942
RN  - 0 (Biomarkers)
RN  - 0 (Troponin)
SB  - IM
MH  - Arrhythmias, Cardiac/diagnosis/physiopathology
MH  - Biomarkers/metabolism
MH  - Chest Pain/*etiology/physiopathology
MH  - Electrocardiography
MH  - Emergency Service, Hospital/statistics & numerical data
MH  - Female
MH  - Heart Arrest/diagnosis/physiopathology
MH  - Heart Rate/physiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Revascularization/statistics & numerical data
MH  - Point-of-Care Systems
MH  - Prospective Studies
MH  - Shock, Cardiogenic/diagnosis/physiopathology
MH  - Triage/*methods
MH  - Troponin/*metabolism
MH  - Vital Signs
OT  - Chest pain
OT  - Electrocardiogram
OT  - Emergency department
OT  - Heart rate variability
OT  - Triage
EDAT- 2017/07/27 06:00
MHDA- 2018/11/20 06:00
CRDT- 2017/07/27 06:00
PHST- 2017/06/19 00:00 [received]
PHST- 2017/07/14 00:00 [revised]
PHST- 2017/07/15 00:00 [accepted]
PHST- 2017/07/27 06:00 [pubmed]
PHST- 2018/11/20 06:00 [medline]
PHST- 2017/07/27 06:00 [entrez]
AID - S0735-6757(17)30583-1 [pii]
AID - 10.1016/j.ajem.2017.07.054 [doi]
PST - ppublish
SO  - Am J Emerg Med. 2018 Feb;36(2):185-192. doi: 10.1016/j.ajem.2017.07.054. Epub
      2017 Jul 17.