title: Relationship Between Physiological Parameters and Acute Coronary Syndrome in Patients Presenting to the Emergency Department With Undifferentiated Chest Pain.
abstract: The investigators of this study sought to examine whether abnormal physiological parameters are associated with increased risk for acute coronary syndrome (ACS) in patients presenting to the emergency department (ED) with chest pain.
  
  
  METHODS
  We used prospectively collected data on adult patients presenting with suspected ACS in 2 EDs in Australia and New Zealand. Trained research nurses collected physiological data including temperature, respiratory rate, heart rate, and systolic blood pressure (SBP) on presentation to the ED. The primary endpoint was ACS within 30 days of presentation, as adjudicated by cardiologists using standardized guidelines. The prognostic utility of physiological parameters for ACS was examined using risk ratios.
  
  
  RESULTS
  Acute coronary syndrome was diagnosed in 384 of the 1951 patients (20%) recruited. Compared with patients whose SBP was between 100 and 140 mm Hg, patients with an SBP of lower than 100 mm Hg or higher than 140 mm Hg were 1.4 times (95% confidence interval, 1.2-1.7) more likely to have ACS. Similarly, compared with patients whose temperature was between 36.5°C and 37.5°C, patients with temperature of lower than 36.5°C or higher than 37.5°C were 1.4 times (95% confidence interval, 1.1-1.6) more likely to have ACS. Heart rate and respiratory rate were not predictors of ACS.
  
  
  CONCLUSIONS
  Patients with abnormal temperature or SBP were slightly more likely to have ACS, but such risk was of too small a magnitude to be useful in clinical decision making. Other physiological parameters (heart rate and respiratory rate) had no prognostic value. The use of physiological parameters cannot reliably confirm or rule out ACS.
authors: Jaimi H. Greenslade, BPsych (Hons), PhD Research Fellow, Department of Emergency Medicine, Royal Brisbane and Women's Hospital; School of Medicine, University of Queensland; and School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia.Daniel Beamish, BSc (Hons) Research Assistant, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.William Parsonage, DM, MRCP, FRACP Cardiologist, Department of Cardiology, Royal Brisbane and Women's Hospital; School of Medicine, University of Queensland; and School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia.Tracey Hawkins, BNursing, GradDip Emerg Nursing Research Nurse, Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.Jessica Schluter, BNursing, PhD Research Nurse, Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.Emily Dalton, BSc, BNursing Research Nurse, Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.Kate Parker, BNursing, BHltSc(Psych) Research Nurse, Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.Martin Than, MBBS Emergency Physician, Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand.Christopher Hammett, MB ChB, FRACP Cardiologist, Department of Cardiology, Royal Brisbane and Women's Hospital, and School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia.Arvin Lamanna, MBBS, FRACP Cardiology Registrar, Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.Louise Cullen, MBBS Emergency Physician, Department of Emergency Medicine, Royal Brisbane and Women's Hospital; School of Medicine, University of Queensland; and School of Public Health, Queensland University of Technology, Brisbane, Queensland, Aust
authors: Jaimi H
authors: JH
authors: Greenslade
authors: Daniel
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authors: Beamish
authors: William
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authors: Parsonage
authors: Tracey
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authors: Hawkins
authors: Jessica
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authors: Schluter
authors: Emily
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authors: Dalton
authors: Kate
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authors: Parker
authors: Martin
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authors: Than
authors: Christopher
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authors: Hammett
authors: Arvin
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authors: Lamanna
authors: Louise
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authors: Cullen
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000209:etiology / Q000503:physiopathology*; D001315:Australia; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012307:Risk Factors; D055986:Vital Signs