World Journal of Emergency Medicine ›› 2023, Vol. 14 ›› Issue (4): 257-264.doi: 10.5847/wjem.j.1920-8642.2023.054
• Original Article • Next Articles
Johan L. van Nieuwkerk1, M. Christien van der Linden2(), Rolf J. Verheul3, Merel van Loon-van Gaalen4, Marije Janmaat5, Naomi van der Linden6
Received:
2022-09-29
Accepted:
2023-02-01
Online:
2023-06-30
Published:
2023-07-01
Contact:
M. Christien van der Linden
E-mail:c.van.der.linden@haaglandenmc.nl
Johan L. van Nieuwkerk, M. Christien van der Linden, Rolf J. Verheul, Merel van Loon-van Gaalen, Marije Janmaat, Naomi van der Linden. The impact of prehospital blood sampling on the emergency department process of patients with chest pain: a pragmatic non-randomized controlled trial[J]. World Journal of Emergency Medicine, 2023, 14(4): 257-264.
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URL: http://wjem.com.cn/EN/10.5847/wjem.j.1920-8642.2023.054
Table 1.
Patient demographics, medical history, risk factors and ED visit characteristics of the total study population (n=506)
Variables | Cases (n=100) | Controls (n=406) | Odds ratio | 95% CI | P-valuea | ||
---|---|---|---|---|---|---|---|
Assessment at general ED, n (%) | 42 (42.0) | 202 (49.8) | 0.73 | 0.47-1.14 | 0.17 | ||
Assessment at chest pain unit, n (%) | 58 (58.0) | 204 (50.2) | |||||
Age, years, median (IQR) | 64 (50-77) | 64 (53-75) | 0.98 | ||||
Gender, male, n (%) | 40 (40.0) | 196 (48.3) | 1.40 | 0.90-2.19 | 0.14 | ||
Medical history, n/total known (%) | |||||||
Diabetesb | 28/98 (28.6) | 49/207 (23.7) | 0.78 | 0.45-1.33 | 0.36 | ||
Hypertensionc | 45/98 (45.9) | 75/205 (36.6) | 0.68 | 0.42-1.11 | 0.12 | ||
Dyslipidemiad | 31/88 (35.2) | 88/201 (43.8) | 1.43 | 0.85-2.41 | 0.17 | ||
Prior cardiovascular diseasee | 36/98 (36.7) | 101/104 (49.5) | 1.69 | 1.03-2.77 | 0.04 | ||
Family history of cardiac eventsf | 24/47 (51.1) | 47/98 (48.0) | 0.88 | 0.44-1.77 | 0.73 | ||
Smoking historyg, n/total known (%) | 0.19 | ||||||
Current | 17/53 (32.1) | 44/119 (37.0) | |||||
Former | 19/53 (35.8) | 27/119 (22.7) | |||||
Never | 17/53 (32.1) | 48/119 (40.3) | |||||
Arrival time, n (%) | 0.04 | ||||||
Day shift (8 am to 4 pm) | 21 (21.0) | 111 (27.3) | |||||
Evening shift (4 pm to midnight) | 47 (47.0) | 135 (33.3) | |||||
Night shift (midnight to 8 am) | 32 (32.0) | 160 (39.4) | |||||
Arrival during extreme busynessh | 22 (22.0) | 99 (24.4) | 0.88 | 0.52-1.48 | 0.62 | ||
Troponin result, n (%) | 0.14 | ||||||
Normal | 62 (62.0) | 273 (67.4) | |||||
Elevated | 29 (29.0) | 82 (20.2) | |||||
Strongly elevated | 9 (9.0) | 50 (12.3) | |||||
Radiology requests, n (%) | 0.73 | 0.42-1.26 | 0.25 | ||||
None | 81 (81.0) | 307 (75.6) | |||||
One or two | 19 (19.0) | 99 (24.4) | |||||
Hospital admission, n (%) | 65 (65.0) | 258 (63.5) | 1.07 | 0.67-1.68 | 0.79 |
Table 2.
Univariate analyses of time intervals
Time intervals | Cases (n=100) | Controls (n=406) | P-value | ||
---|---|---|---|---|---|
Total study population | |||||
Blood sample arrival time, min, median (IQR) a | 13 (8.3-18.8) | 26 (19.0-34.0) | <0.001 | ||
Troponin turnaround time, min, median (IQR) a | 53 (42.3-66.0) | 64 (53.0-81.0) | <0.001 | ||
Patients who were assessed at the general ED | Cases (n=42) | Controls (n=202) | |||
EDLOS, min, median (IQR)a | 180 (126-222) | 181 (134-227) | 0.26 |
Table 3.
Factors independently associated with log-transformed troponin turnaround time
Factors | Initial model | Final model | |||||
---|---|---|---|---|---|---|---|
B | 95% CI | P-valuea | B | 95% CI | P-valuea | ||
Constant | 1.50 | 1.24 - 1.77 | <0.001 | 1.73 | 1.70 - 1.75 | <0.001 | |
Prehospital blood draw | -0.08 | -0.17 - -0.04 | 0.06 | -0.10 | -0.13 - -0.07 | <0.001 | |
Age | -0.001 | -0.003 - 0.002 | 0.62 | ||||
Gender, male | -0.04 | -0.10 - 0.03 | 0.27 | ||||
Smoking history | 0.02 | -0.02 - 0.06 | 0.26 | ||||
Diabetes mellitus | 0.05 | -0.04 - 0.14 | 0.29 | ||||
Hypertension | 0.005 | -0.07 - 0.08 | 0.90 | ||||
Dyslipidemia | 0.06 | -0.04 - 0.15 | 0.23 | ||||
Prior cardiovascular disease | -0.003 | -0.09 - 0.09 | 0.94 | ||||
Family history of coronary disease | 0.001 | -0.06 - 0.06 | 0.799 | ||||
Arrival at day shift | -0.03 | -0.10 - 0.05 | 0.48 | ||||
Arrival at evening shift | 0.08 | -0.03 - 0.19 | 0.17 | 0.09 | 0.07 - 0.12 | <0.001 | |
Busyness at arrival | 0.001 | -0.001 - 0.002 | 0.47 | ||||
Troponin result | 0.09 | 0.02 - 0.17 | 0.02 | 0.06 | 0.04 - 0.07 | <0.001 | |
Second troponin draw | -0.02 | -0.10 - 0.05 | 0.56 | ||||
Radiology request | -0.03 | -0.09 - 0.04 | 0.45 | ||||
Hospital admission | 0.001 | -0.10 - 0.10 | 0.99 | -0.03 | -0.06 - 0.00 | 0.046 |
Table 4.
Factors independently associated with log-transformed ED length of stay*
Factors | Initial model | Final model | |||||
---|---|---|---|---|---|---|---|
B | 95% CI | P-valuea | Bb | 95% CI | P-valuea | ||
Constant | 2.25 | 1.99 - 2.51 | <0.001 | 2.09 | 2.01 -2.17 | <0.001 | |
Prehospital blood draw | -0.02 | -0.10 - 0.06 | 0.59 | -0.10 | -0.16 - -0.04 | 0.001 | |
Age | 0.003 | 0.001 - 0.005 | <0.001 | 0.002 | 0.001 - 0.003 | 0.02 | |
Gender, male | -0.03 | -0.06 - 0.06 | 0.93 | ||||
Smoking history | 0.009 | -0.03 - 0.04 | 0.61 | ||||
Diabetes mellitus | -0.04 | -0.12 - 0.05 | 0.41 | ||||
Hypertension | -0.02 | -0.10 - 0.05 | 0.53 | ||||
Dyslipidemia | 0.04 | -0.05 - 0.13 | 0.41 | ||||
Prior cardiovascular disease | -0.08 | -0.16 - 0.007 | 0.07 | ||||
Family history of coronary disease | 0.02 | -0.05 - 0.08 | 0.64 | ||||
Arrival at day shift | -0.008 | -0.08 - 0.07 | 0.82 | ||||
Arrival at evening shift | -0.06 | -0.17 - 0.05 | 0.27 | ||||
Busyness at arrival | 0.001 | -0.001 - 0.002 | 0.76 | ||||
Troponin result | -0.11 | -0.18 - -0.03 | 0.004 | ||||
Second troponin draw | 0.16 | 0.09 - 0.23 | <0.001 | 0.20 | 0.15 - 0.25 | <0.001 | |
Radiology request | 0.06 | -0.001 - 0.13 | 0.06 | 0.05 | 0.003 - 0.09 | 0.04 | |
Hospital admission | 0.02 | -0.08 - 0.12 | 0.70 |
1 | Cotton BA, Jerome R, Collier BR, Khetarpal S, Holevar M, Tucker B, et al. Guidelines for prehospital fluid resuscitation in the injured patient. J Trauma. 2009; 67(2): 389-402. |
2 | van Schuppen H, Bierens J. Understanding the prehospital physician controversy. Step 1: comparing competencies of ambulance nurses and prehospital physicians. Eur J Emerg Med. 2011; 18(6): 322-7. |
3 |
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018; 72(18): 2231-64.
doi: S0735-1097(18)36941-9 pmid: 30153967 |
4 |
Prottengeier J, Jess N, Harig F, Gall C, Schmidt J, Birkholz T. Can we rely on out-of-hospital blood samples? A prospective interventional study on the pre-analytical stability of blood samples under prehospital emergency medicine conditions. Scand J Trauma Resusc Emerg Med. 2017; 25(1): 24.
doi: 10.1186/s13049-017-0371-3 |
5 |
Coventry LL, Jacob AM, Davies HT, Stoneman L, Keogh S, Jacob ER. Drawing blood from peripheral intravenous cannula compared with venepuncture: a systematic review and meta-analysis. J Adv Nurs. 2019; 75(11): 2313-39.
doi: 10.1111/jan.14078 pmid: 31115075 |
6 |
Harrison G, Speroni KG, Dugan LS, Daniel MG. A comparison of the quality of blood specimens drawn in the field by EMS versus specimens obtained in the emergency department. J Emerg Nurs. 2010; 36(1): 16-20.
doi: 10.1016/j.jen.2008.11.001 pmid: 20109772 |
7 |
Zhang L, Cao SY, Marsh N, Ray-Barruel G, Flynn J, Larsen E, et al. Infection risks associated with peripheral vascular catheters. J Infect Prev. 2016; 17(5): 207-13.
doi: 10.1177/1757177416655472 |
8 |
Dal-Ré R, Janiaud P, Ioannidis JPA. Real-world evidence: how pragmatic are randomized controlled trials labeled as pragmatic? BMC Med. 2018; 16(1): 49.
doi: 10.1186/s12916-018-1038-2 pmid: 29615035 |
9 |
Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016; 37(3):267-315.
doi: 10.1093/eurheartj/ehv320 |
10 |
Six AJ, Cullen L, Backus BE, Greenslade J, Parsonage W, Aldous S, et al. The HEART score for the assessment of patients with chest pain in the emergency department: a multinational validation study. Crit Pathw Cardiol. 2013; 12(3): 121-6.
doi: 10.1097/HPC.0b013e31828b327e pmid: 23892941 |
11 |
Weiss SJ, Derlet R, Arndahl J, Ernst AA, Richards J, Fernández-Frackelton M, et al. Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS). Acad Emerg Med. 2004; 11(1): 38-50.
doi: 10.1197/j.aem.2003.07.017 pmid: 14709427 |
12 |
van der Linden MC, van Loon M, Gaakeer MI, Richards JR, Derlet RW, van der Linden N. A different crowd, a different crowding level? The predefined thresholds of crowding scales may not be optimal for all emergency departments. Int Emerg Nurs. 2018; 41: 25-30.
doi: S1755-599X(18)30068-5 pmid: 29880260 |
13 |
Lindner H, Schmedel W, Martin M, Heidt M, McMahon C, Romans J. The impact of prehospital blood collection on time to laboratory test results and emergency department length of stay. Adv Emerg Nurs J. 2010; 32(4): 354-9.
doi: 10.1097/TME.0b013e3181fd4f7d |
14 |
DuCharme B, Macci Bires A, Montanye E, Khan M, DuCharme S, Linse M, et al. Effect of prehospital blood draws on length of stay for chest pain patients in the emergency department: a pilot study. Crit Care Nurs Q. 2019; 42(2): 208-14.
doi: 10.1097/CNQ.0000000000000257 pmid: 30807348 |
15 | Lee-Lewandrowski E, Corboy D, Lewandrowski K, Sinclair J, McDermot S, Benzer TI. Implementation of a point-of-care satellite laboratory in the emergency department of an academic medical center. Impact on test turnaround time and patient emergency department length of stay. Arch Pathol Lab Med. 2003; 127(4): 456-60. |
16 |
Holland LL, Smith LL, Blick KE. Reducing laboratory turnaround time outliers can reduce emergency department patient length of stay: an 11-hospital study. Am J Clin Pathol. 2005; 124(5): 672-4.
doi: 10.1309/E9QP-VQ6G-2FBV-MJ3B pmid: 16203280 |
17 |
van der Linden C, Reijnen R, Derlet RW, Lindeboom R, van der Linden N, Lucas C, et al. Emergency department crowding in The Netherlands: managers’ experiences. Int J Emerg Med. 2013; 6(1): 41.
doi: 10.1186/1865-1380-6-41 |
18 |
Kawano T, Nishiyama K, Hayashi H. Execution of diagnostic testing has a stronger effect on emergency department crowding than other common factors: a cross-sectional study. PLoS One. 2014; 9(10): e108447.
doi: 10.1371/journal.pone.0108447 |
19 |
van der Linden MC, Quarles van Ufford HM, Projectgroup Medical Specialists, van der Linden N. The impact of a multimodal intervention on emergency department crowding and patient flow. Int J Emerg Med. 2019; 12(1): 21.
doi: 10.1186/s12245-019-0238-7 pmid: 31455260 |
20 |
Hwang U, Baumlin K, Berman J, Chawla NK, Handel DA, Heard K, et al. Emergency department patient volume and troponin laboratory turnaround time. Acad Emerg Med. 2010; 17(5): 501-7.
doi: 10.1111/j.1553-2712.2010.00738.x pmid: 20536804 |
21 |
Amritzer MA, Muntlin Å, Berg LM, Göransson KE. Nursing staff ratio and skill mix in Swedish emergency departments: a national cross-sectional benchmark study. J Nurs Manag. 2021; 29(8): 2594-602.
doi: 10.1111/jonm.v29.8 |
22 |
Ball JE, Murrells T, Rafferty AM, Morrow E, Griffiths P. ‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care. BMJ Qual Saf. 2014; 23(2): 116-25.
doi: 10.1136/bmjqs-2012-001767 |
23 | Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016; 355: i4919. |
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