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DOUGLAS SPEAKE and COLLEAGUES discuss nurse detection of high-risk patients with cardiac chest pain using the Manchester Triage System
Aim: To assess the ability of nurses using the Manchester Triage System (MTS) to identify those patients with chest pain requiring immediate electrocardiogram (ECG) and physician assessment within ten minutes.
Method: A four-week prospective cohort of all patients attending with chest pain compared detection of risk by nurses using the MTS to that of researchers using best available evidence-based prognostic indicators from history.
Results: The study of 167 patients showed that nurses using MTS had a sensitivity of 86.8 per cent (95 per cent confidence interval (CI), 78.4-92.3 per cent) and a specificity of 72.4 per cent (95 per cent CI, 61.4-81.2 per cent) when identifying high risk cardiac chest pain.
Conclusion: Nurses using the MTS are a sensitive tool for identifying high risk cardiac chest pain but further work is required to assess whether additional training can improve sensitivity.
The Manchester Triage System (MTS) (Manchester Triage Group 1997) is widely used in UK emergency departments and is gaining favour in other parts of Europe. The system is based by necessity on the consensus view of a group of senior emergency nurses and physicians rather than an existing evidence base. As such there is a need for further work to validate and update the discriminators used by the system. Only one such paper has been published so far (Cooke and Jinks 1999) and this shows an acceptable overall sensitivity to detect critically ill patients.
Patients presenting to emergency departments (EDs) with chest pain form a heterogeneous group. According to one study, around 8 per cent have acute myocardial infarction, a further 9 per cent have unstable angina and 55 per cent have non-cardiac causes (Pope et al 2000).
It is accepted that early intervention in the group with cardiac causes can reduce mortality and morbidity (Gruppo ltaliano per Io Studio della Streptochinasi nell'Infarto Miocardio 1986, second International Study...