title: Risk stratification of chest pain patients in the emergency department by a nurse utilizing a point of care protocol.
abstract: OBJECTIVE
  Risk stratification of patients with ischaemic type chest pain assessed in the emergency department utilizing a point of care (POC) protocol.
  
  
  METHODS
  Patient demographics, cardiac biomarkers, management and follow-up at 6 months were reviewed for patients seen over 20 months.
  
  
  RESULTS
  Out of 546 patients, 351 (64%) were admitted. The diagnoses after admission were confirmed as acute myocardial infarction in 59 patients and unstable angina, (cTroponin T<0.09 ng/ml) in 92 patients. The c-statistic of the receiver operating curves for myocardial infarction (myocardial infarction, cTroponinT at 12 h >0.09 ng/ml) as determined by the POC assay was cTroponin I=0.884, CK-MB=0.883, myoglobin=0.845 and beta-type natriuretic peptide (BNP)=0.755. The c-statistic for the same sample assessed by the hospital laboratory was cTroponin T=0.893: for CK-MB within 12 h of admission it was 0.918; the 12 h cTroponin T was 0.982 and within 24 h of admission NT pro-BNP was 0.789. POC BNP in patients admitted was 68 ng/l (median) vs. 24 ng/l (median) for those not admitted, (P<0.001). POC BNP for patients admitted with unstable angina (12 h cTroponin T <0.09 ng/ml) was 47 ng/l (median, P<0.001). At 6 months, 14 patients had died; five during admission, two within 30 days and seven up to 6 months. During admission two died from heart failure, two with respiratory tract infection and one from carcinoma. Of those not admitted one had died from asbestosis.
  
  
  CONCLUSIONS
  Risk stratification by a specialist nurse utilizing a POC protocol is an appropriate means of assessing patients with chest pain.
authors.affiliation: Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Hamilton
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Swales
authors.forename: Johanne
authors.initials: J
authors.lastname: Neill
authors.forename: John C
authors.initials: JC
authors.lastname: Murphy
authors.forename: Karen M
authors.initials: KM
authors.lastname: Darragh
authors.forename: Laurence G
authors.initials: LG
authors.lastname: Rocke
authors.forename: Jennifer
authors.initials: J
authors.lastname: Adgey
mesh_terms: D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000150:complications / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000209:etiology*; D016529:Emergency Nursing; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009726:Nurses; D019095:Point-of-Care Systems; D012372:ROC Curve; D012189:Retrospective Studies; D014218:Triage / Q000379:methods*; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T; D020097:Natriuretic Peptide, Brain