Towards enhanced telephone triage for chest pain: a Delphi study to define life-threatening conditions that must be identified

BMC Emergency Medicine

Ahmed Alotaibi¹  Richard Body²  Simon Carley³  Elspeth Pennington⁴ 

[1] Division of Cardiovascular Sciences, Core Technology Facility, University of Manchester, 46 Grafton St, M13 9WU, Manchester, UK;College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;Division of Cardiovascular Sciences, Core Technology Facility, University of Manchester, 46 Grafton St, M13 9WU, Manchester, UK;Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK;Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK;Faculty of Health, Social Care & Psychology, Manchester Metropolitan University, Manchester, UK;North West Ambulance Service NHS Trust, Bolton, UK;

关键词: Prehospital;    Triage;    Telephone-triage;    EMS;    Chest pain;    Life-threatening condition;    Dispatch;   

DOI  :  10.1186/s12873-021-00553-w

来源: Springer

【 摘 要 】

BackgroundImproving telephone triage for patients with chest pain has been identified as a national research priority. However, there is a lack of strong evidence to define the life-threatening conditions (LTCs) that telephone triage ought to identify. Therefore, we aimed to build consensus for the LTCs associated with chest pain that ought to be identified during telephone triage for emergency calls.MethodsWe conducted a Delphi study in three rounds. Twenty experts in pre-hospital care and emergency medicine experience from the UK were invited to participate. In round I, experts were asked to list all LTCs that would require priority 1, 2, and 4 ambulance responses. Round II was a ranking evaluation, and round III was a consensus round. Consensus level was predefined at > = 70%.ResultsA total of 15 participants responded to round one and 10 to rounds two and three. Of 185 conditions initially identified by the experts, 26 reached consensus in the final round. Ten conditions met consensus for requiring priority 1 response: oesophageal perforation/rupture; ST elevation myocardial infarction; non-ST elevation myocardial infarction with clinical compromise (defined, also by consensus, as oxygen saturation < 90%, heart rate < 40/min or systolic blood pressure < 90 mmHg); acute heart failure; cardiac tamponade; life-threatening asthma; cardiac arrest; tension pneumothorax and massive pulmonary embolism. An additional six conditions met consensus for priority 2 response, and three for priority 4 response.ConclusionUsing expert consensus, we have defined the LTCs that may present with chest pain, which ought to receive a high-priority ambulance response. This list of conditions can now form a composite primary outcome for future studies to derive and validate clinical prediction models that will optimise telephone triage for patients with a primary complaint of chest pain.

【 授权许可】

CC BY