Prehospital Translation of Chest Pain Tools

NCT ID: NCT03494556

Last Updated: 2023-07-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

365 participants

Study Classification

OBSERVATIONAL

Study Start Date

2018-04-18

Study Completion Date

2020-09-09

Brief Summary

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Decision aids such as the HEART Pathway, Emergency Department Assessment of Chest Pain Score (EDACS), Revised Geneva Score and PERC Score have similar ability to accurately risk stratify Emergency Department (ED) patients with possible Acute Coronary Syndrome (ACS) and Pulmonary Embolism (PE) and have become standard practice in the ED setting. This study seeks to determine whether prehospital use of these decision aids is feasible and determine which are the most sensitive and specific for prediction of ACS and PE, respectively.

Detailed Description

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To accomplish our Specific Aims the study team proposes a prospective, observational pilot study of four rapid risk stratification tools, the HEART Pathway Score, EDACS score, revised Geneva score, and PERC score, among 250 chest pain patients within two large EMS systems. The proposed pilot study has broad-based support from local and state EMS agencies, including Cumberland and New Hanover County EMS agencies. Each tool will be pilot tested and compared in the prehospital setting for feasibility and accuracy. Paramedics will be trained in risk stratification tool use and then will prospectively collect the clinical data needed to calculate each risk stratification score when caring for adults with chest pain. Completed paramedic risk assessments will be used to determine feasibility. Patients will be followed for 30 days to determine occurrence of ACS and PE events and the sensitivity of each risk stratification decision aid will be determined.

Conditions

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Acute Coronary Syndrome Pulmonary Embolism

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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No Intervention

Paramedic will use data collected during routine care to complete four risk stratification tools.

Data Collection

Intervention Type OTHER

Paramedic will use data collected during routine care to complete four risk stratification tools.

Interventions

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Data Collection

Paramedic will use data collected during routine care to complete four risk stratification tools.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Age greater than or equal to 21
* Acute non-traumatic chest pain
* Transported by Cumberland or New Hanover County EMS to a local Emergency Department

Exclusion Criteria

* Patients with evidence of ST elevation myocardial infarction (STEMI) on ECG
* Inter-facility transports (transfers)
* Patients with unstable vital signs
* Prisoners
* Non-english speakers
Minimum Eligible Age

21 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Cape Fear Valley Mobile Integrated Healthcare Cumberland County EMS

UNKNOWN

Sponsor Role collaborator

New Hanover Regional Medical Center EMS

UNKNOWN

Sponsor Role collaborator

Wake Forest University Health Sciences

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jason Stopyra, MD

Role: PRINCIPAL_INVESTIGATOR

Wake Forest University Health Sciences

Locations

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Cape Fear Valley Mobile Integrated Healthcare Cumberland County EMS

Fayetteville, North Carolina, United States

Site Status

New Hanover Regional Medical Center EMS

Wilmington, North Carolina, United States

Site Status

Countries

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United States

References

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Saddichha S, Saxena MK. Is every chest pain a cardiac event? : an audit of patients with chest pain presenting to emergency services in India. Intern Emerg Med. 2009 Jun;4(3):235-9. doi: 10.1007/s11739-009-0246-3. Epub 2009 Apr 15.

Reference Type BACKGROUND
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Burman RA, Zakariassen E, Hunskaar S. Acute chest pain - a prospective population based study of contacts to Norwegian emergency medical communication centres. BMC Emerg Med. 2011 Jul 21;11:9. doi: 10.1186/1471-227X-11-9.

Reference Type BACKGROUND
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Mahler SA, Miller CD, Hollander JE, Nagurney JT, Birkhahn R, Singer AJ, Shapiro NI, Glynn T, Nowak R, Safdar B, Peberdy M, Counselman FL, Chandra A, Kosowsky J, Neuenschwander J, Schrock JW, Plantholt S, Diercks DB, Peacock WF. Identifying patients for early discharge: performance of decision rules among patients with acute chest pain. Int J Cardiol. 2013 Sep 30;168(2):795-802. doi: 10.1016/j.ijcard.2012.10.010. Epub 2012 Oct 30.

Reference Type BACKGROUND
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Mahler SA, Riley RF, Hiestand BC, Russell GB, Hoekstra JW, Lefebvre CW, Nicks BA, Cline DM, Askew KL, Elliott SB, Herrington DM, Burke GL, Miller CD. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes. 2015 Mar;8(2):195-203. doi: 10.1161/CIRCOUTCOMES.114.001384. Epub 2015 Mar 3.

Reference Type BACKGROUND
PMID: 25737484 (View on PubMed)

Thang ND, Sundstrom BW, Karlsson T, Herlitz J, Karlson BW. ECG signs of acute myocardial ischemia in the prehospital setting of a suspected acute coronary syndrome and its association with outcomes. Am J Emerg Med. 2014 Jun;32(6):601-5. doi: 10.1016/j.ajem.2014.03.006. Epub 2014 Mar 15.

Reference Type BACKGROUND
PMID: 24731933 (View on PubMed)

Mahler SA, Hiestand BC, Goff DC Jr, Hoekstra JW, Miller CD. Can the HEART score safely reduce stress testing and cardiac imaging in patients at low risk for major adverse cardiac events? Crit Pathw Cardiol. 2011 Sep;10(3):128-33. doi: 10.1097/HPC.0b013e3182315a85.

Reference Type BACKGROUND
PMID: 21989033 (View on PubMed)

Flaws D, Than M, Scheuermeyer FX, Christenson J, Boychuk B, Greenslade JH, Aldous S, Hammett CJ, Parsonage WA, Deely JM, Pickering JW, Cullen L. External validation of the emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP). Emerg Med J. 2016 Sep;33(9):618-25. doi: 10.1136/emermed-2015-205028. Epub 2016 Jul 12.

Reference Type BACKGROUND
PMID: 27406833 (View on PubMed)

Than M, Flaws D, Sanders S, Doust J, Glasziou P, Kline J, Aldous S, Troughton R, Reid C, Parsonage WA, Frampton C, Greenslade JH, Deely JM, Hess E, Sadiq AB, Singleton R, Shopland R, Vercoe L, Woolhouse-Williams M, Ardagh M, Bossuyt P, Bannister L, Cullen L. Development and validation of the Emergency Department Assessment of Chest pain Score and 2 h accelerated diagnostic protocol. Emerg Med Australas. 2014 Feb;26(1):34-44. doi: 10.1111/1742-6723.12164. Epub 2014 Jan 15.

Reference Type BACKGROUND
PMID: 24428678 (View on PubMed)

Le Gal G, Righini M, Roy PM, Sanchez O, Aujesky D, Bounameaux H, Perrier A. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006 Feb 7;144(3):165-71. doi: 10.7326/0003-4819-144-3-200602070-00004.

Reference Type BACKGROUND
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PMID: 15304025 (View on PubMed)

Havas S. The ACCORD Trial and control of blood glucose level in type 2 diabetes mellitus: time to challenge conventional wisdom. Arch Intern Med. 2009 Jan 26;169(2):150-4. doi: 10.1001/archinternmed.2008.518. No abstract available.

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Reference Type BACKGROUND
PMID: 22923432 (View on PubMed)

Pollack CV, Schreiber D, Goldhaber SZ, Slattery D, Fanikos J, O'Neil BJ, Thompson JR, Hiestand B, Briese BA, Pendleton RC, Miller CD, Kline JA. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). J Am Coll Cardiol. 2011 Feb 8;57(6):700-6. doi: 10.1016/j.jacc.2010.05.071.

Reference Type BACKGROUND
PMID: 21292129 (View on PubMed)

Other Identifiers

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IRB00048904

Identifier Type: -

Identifier Source: org_study_id

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