Exploring the complex interactions of baseline patient factors to improve nursing triage of acute coronary syndrome.
Stephanie O Frisch, Julissa Brown, Ziad Faramand and 6 others
PMID 32491206WHAT IT FOUND
At ED triage, older age, non-Caucasian race, higher respiratory rate, and higher heart rate in insulin-treated diabetes were linked to ACS.
This is not a tested triage tool.
Key findings
01The final model included age, race, first ED respiratory rate, and the interaction of first ED heart rate by Type II diabetes receiving insulin for glycemic control.
02For Type II diabetics receiving insulin for glycemic control, higher first ED heart rate was associated with increased predicted probability of ACS.
03The final model had an area under the receiver operating characteristic curve of 0.745 (95% confidence interval 0.695 to 0.790).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included only adults who arrived by ambulance with a prehospital ECG, so it may not apply to patients who arrive by other means. It used records from one healthcare system and extracted factors retrospectively, so some relevant information, such as home medications, was missing. The study did not test whether using these factors improves triage decisions or patient outcomes. Race was analysed as Caucasian versus non-Caucasian, so the finding does not distinguish Black patients from other races. The authors state beta-blocker medication use was not available for analysis, which could influence the diabetes and heart rate interaction.
Declared interests
The authors declare no conflicts of interest. The article is marked as NIH extramural and non-U.S. government funded.
The easy way to misread this
Do not treat these factors as a validated triage rule. The study built a model from existing records and did not test whether using it improves triage or patient outcomes.