Patient-reported symptoms improve prediction of acute coronary syndrome in the emergency department.
Jessica K Zègre-Hemsey, Larisa A Burke, Holli A DeVon
PMID 30168588WHAT IT FOUND
Adding patient-reported symptoms like sweating and shoulder pain to ECG and troponin results improved the prediction of acute coronary syndrome.
Sweating specifically helped identify heart attacks and predicted shorter delays in seeking emergency care.
Key findings
01ECG signs and troponin levels were the strongest predictors of ACS, but symptoms like shoulder pain, sweating, high distress, and older age also significantly predicted diagnosis.
02Sweating was the only symptom that predicted a shorter prehospital delay in patients with ACS.
03Shortness of breath and unusual fatigue predicted longer prehospital delays, suggesting patients do not recognize these as cardiac symptoms.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The symptom checklist only recorded presence or absence (yes/no), so the intensity or specific quality of symptoms could not be analyzed. Prehospital delay times relied on patients' self-reported memory of when symptoms started, which is subject to recall bias. The study could not verify if all sites used the same ECG interpretation criteria or if different clinicians analyzed the ECGs consistently. There was missing data for ECG signs (14.1%) and prehospital delay (7.8%), which was handled statistically but may affect precision.
Declared interests
The authors declare no conflicts of interest. The study was supported by the National Institutes of Health.
The easy way to misread this
Do not assume that patient-reported symptoms can replace ECG or troponin testing. These symptoms only improved prediction when used in conjunction with standard diagnostic tests; they are not standalone diagnostic tools.