Diagnostic Accuracy of Prehospital Clinical Prediction Models to Identify Short-term Outcomes in Patients with Acute Coronary Syndromes: A Systematic Review

Nehme, Ziad; Boyle, Malcolm; Brown, Ted

doi:10.1016/j.jemermed.2012.07.078

Cited by 10 publications

(5 citation statements)

References 45 publications

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“…A risk assessment tool for chest pain patients, to be used in the prehospital setting, has been called for in previous research. [25][26][27] Such a tool might reduce arbitrariness in patient assessment and excess utilisation of emergency care.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Prehospital stratification in acute chest pain patient into high risk and low risk by emergency medical service: a prospective cohort study

et al. 2021

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ObjectivesTo describe contemporary characteristics and diagnoses in prehospital patients with chest pain and to identify factors suitable for the early recognition of high-risk and low-risk conditions.DesignProspective observational cohort study.SettingTwo centre study in a Swedish county emergency medical services (EMS) organisation.ParticipantsUnselected inclusion of 2917 patients with chest pain contacting the EMS due to chest pain during 2018.Primary outcome measuresLow-risk or high-risk condition, that is, occurrence of time-sensitive diagnosis on hospital discharge.ResultsOf included EMS missions, 68% concerned patients with a low-risk condition without medical need of acute hospital treatment in hindsight. Sixteen per cent concerned patients with a high-risk condition in need of rapid transport to hospital care. Numerous variables with significant association with low-risk or high-risk conditions were found. In total high-risk and low-risk prediction models shared six predictive variables of which ST-depression on ECG and age were most important. Previously known risk factors such as history of acute coronary syndrome, diabetes and hypertension had no predictive value in the multivariate analyses. Some aspects of the symptoms such as pain intensity, pain in the right arm and paleness did on the other hand appear to be helpful. The area under the curve (AUC) for prediction of low-risk candidates was 0.786 and for high-risk candidates 0.796. The addition of troponin in a subset increased the AUC to >0.8 for both.ConclusionsA majority of patients with chest pain cared for by the EMS suffer from a low-risk condition and have no prognostic reason for acute hospital care given their diagnosis on hospital discharge. A smaller proportion has a high-risk condition and is in need of prompt specialist care. Building models with good accuracy for prehospital identification of these groups is possible. The use of risk stratification models could make a more personalised care possible with increased patient safety.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Prehospital stratification in acute chest pain patient into high risk and low risk by emergency medical service: a prospective cohort study

et al. 2021

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“…[21][22][23][24] This systematic review focused on evaluating the diagnostic accuracy of POC cTn assays when used in the prehospital setting. An earlier systematic review by Nehme, et al 25 aimed to evaluate the diagnostic accuracy of clinical prediction rules for potential use in a prehospital emergency environment, using data that "were not reliant on tests unavailable out of the hospital," but found no evidence of any rules that could be used in practice. Since that time, studies have evaluated the History, ECG, Age, Risk Factors, and Troponin (HEART) score, a modified HEART score, and a History, ECG, Age, and Risk Factors (HEAR) score (the HEART score without requiring cTn testing) in the prehospital setting, albeit without using a POC cTn device to test prehospital blood samples.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of Prehospital Point-of-Care Troponin Tests to Rule Out Acute Myocardial Infarction: A Systematic Review

Alghamdi

Alotaibi

Alharbi

et al. 2020

Prehosp. Disaster med.

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Abstract Introduction: Chest pain is one of the most common reasons for 999 calls and transfers to the emergency department (ED). In these patients, acute myocardial infarction (AMI) is often the diagnosis that clinicians are seeking to exclude. However, only a minority of those patients have AMI, causing a substantial financial burden to health services. Cardiac troponin (cTn) is the reference standard biomarker for the diagnosis of AMI. Several commercially available point-of-care (POC) cTn assays are portable and could feasibly be used in an ambulance. The aim of this paper is to systematically review existing evidence for the use of POC cTn assays in the prehospital setting to rule out AMI. Methods: A systematic search was conducted on EMBASE, MEDLINE, and CINAHL Plus databases, reference lists, and relevant grey literature, including combinations of the relevant terms. Papers published in English language since the year 2000 were eligible for inclusion. A narrative synthesis of the evidence was then undertaken. Results: The initial search and cross-referencing revealed a total of 350 papers, of which 243 were excluded. Seven papers were included in the systematic literature review. Conclusion: Current evidence does not support the use of POC troponin assays to exclude AMI due to issues with diagnostic accuracy and insufficient high-quality evidence.

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“…A systematic review from 2016 found no similar triage tools from the era of cardiac troponin testing that have been validated in the emergency setting [13]. Another systematic review, from 2013, which focused on clinical prediction models for use in the prehospital setting, identified five relevant studies but none have been validated to ‘rule out’ ACS without biomarker testing and based on contemporary reference standards [14].…”

Section: Discussionmentioning

confidence: 99%

Enhanced triage for patients with suspected cardiac chest pain: the History and Electrocardiogram-only Manchester Acute Coronary Syndromes decision aid

Alghamdi

Howard

Reynard

et al. 2019

European Journal of Emergency Medicine

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Diagnostic Accuracy of Prehospital Clinical Prediction Models to Identify Short-term Outcomes in Patients with Acute Coronary Syndromes: A Systematic Review

Cited by 10 publications

References 45 publications

Prehospital stratification in acute chest pain patient into high risk and low risk by emergency medical service: a prospective cohort study

Prehospital stratification in acute chest pain patient into high risk and low risk by emergency medical service: a prospective cohort study

Diagnostic Performance of Prehospital Point-of-Care Troponin Tests to Rule Out Acute Myocardial Infarction: A Systematic Review

Enhanced triage for patients with suspected cardiac chest pain: the History and Electrocardiogram-only Manchester Acute Coronary Syndromes decision aid

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