Patient-Reported Symptoms of Acute Coronary Syndrome in the Prehospital Period in a Prospective Study: Implications for Emergency Nurse Triage, Diagnosis, and Clinical Outcomes.
Jessica K Zègre-Hemsey, Eugenia Wong, Jamie Crandell and 8 others
PMID 40455184WHAT IT FOUND
In suspected ACS, ambulance sweating and ED chest pressure, chest discomfort, or unusual fatigue were linked to final ACS diagnosis.
Most symptoms eased before ED arrival, but unusual fatigue rose. Shortness of breath was linked to adverse events.
Key findings
01Sweating in the ambulance was associated with 3.24 times the adjusted odds of a final ACS diagnosis after controlling for age, sex, and race.
02Nine of 13 symptoms changed significantly between ambulance and ED arrival, and unusual fatigue was the only symptom that increased.
03Shortness of breath in the ambulance or ED was associated with odds ratios of 3.96 and 3.26 for adverse events, but only 17 patients had adverse events.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was single-site and included only English-speaking patients, so the symptom patterns may not apply to other settings or languages. Only 17 patients had adverse events, so the adverse-event associations are underpowered and exploratory. Many statistical comparisons were made, so isolated significant results may be chance findings. Prehospital analgesic and nitroglycerin use was not recorded, so symptom changes between ambulance and ED cannot be explained. Consent was sought after ED arrival or after discharge for some patients, and patients with suspected STEMI or instability went directly to the catheterization lab, so symptom recall bias needs to be considered. Observational design cannot show that symptoms caused ACS or adverse outcomes.
Declared interests
No author conflict-of-interest declaration is provided; the article is listed as NIH extramural research support.
The easy way to misread this
Do not treat any single symptom as proof of ACS or as a stand-alone triage rule. The study was observational, had only 17 adverse events, and made many statistical comparisons, so some associations may be chance.