Use of Self-Reported Computerized Medical History Taking for Acute Chest Pain in the Emergency Department – the Clinical Expert Operating System Chest Pain Danderyd Study (CLEOS-CPDS): Prospective Cohort Study (Preprint)

BACKGROUND Chest pain is one of the most common chief complaints in emergency departments (EDs). Collecting an adequate medical history is challenging but essential in order to use recommended risk scores such as the HEART score (based on history, electrocardiogram, age, risk factors, and troponin). Self-reported computerized history taking (CHT) is a novel method to collect structured medical history data directly from the patient through a digital device. CHT is rarely used in clinical practice, and there is a lack of evidence for utility in an acute setting. OBJECTIVE This substudy of the Clinical Expert Operating System Chest Pain Danderyd Study (CLEOS-CPDS) aimed to evaluate whether patients with acute chest pain can interact effectively with CHT in the ED. METHODS Prospective cohort study on self-reported medical histories collected from acute chest pain patients using a CHT program on a tablet. Clinically stable patients aged 18 years and older with a chief complaint of chest pain, fluency in Swedish, and a nondiagnostic electrocardiogram or serum markers for acute coronary syndrome were eligible for inclusion. Patients unable to carry out an interview with CHT (eg, inadequate eyesight, confusion or agitation) were excluded. Effectiveness was assessed as the proportion of patients completing the interview and the time required in order to collect a medical history sufficient for cardiovascular risk stratification according to HEART score. RESULTS During 2017-2018, 500 participants were consecutively enrolled. The age and sex distribution (mean 54.3, SD 17.0 years; 213/500, 42.6% women) was similar to that of the general chest pain population (mean 57.5, SD 19.2 years; 49.6% women). Common reasons for noninclusion were language issues (182/1000, 18.2%), fatigue (158/1000, 15.8%), and inability to use a tablet (152/1000, 15.2%). Sufficient data to calculate HEART score were collected in 70.4% (352/500) of the patients. Key modules for chief complaint, cardiovascular history, and respiratory history were completed by 408 (81.6%), 339 (67.8%), and 291 (58.2%) of the 500 participants, respectively, while 148 (29.6%) completed the entire interview (in all 14 modules). Factors associated with completeness were age 18-69 years (all key modules: Ps<.001), male sex (cardiovascular: P=.04), active workers (all key modules: Ps<.005), not arriving by ambulance (chief complaint: P=.03; cardiovascular: P=.045), and ongoing chest pain (complete interview: P=.002). The median time to collect HEART score data was 23 (IQR 18-31) minutes and to complete an interview was 64 (IQR 53-77) minutes. The main reasons for discontinuing the interview prior to completion (n=352) were discharge from the ED (101, 28.7%) and tiredness (95, 27.0%). CONCLUSIONS A majority of patients with acute chest pain can interact effectively with CHT on a tablet in the ED to provide sufficient data for risk stratification with a well-established risk score. The utility was somewhat lower in patients 70 years and older, in patients arriving by ambulance, and in patients without ongoing chest pain. Further studies are warranted to assess whether CHT can contribute to improved management and prognosis in this large patient group. CLINICALTRIAL ClinicalTrials.gov NCT03439449; https://clinicaltrials.gov/ct2/show/NCT03439449 INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2019-031871

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Use of Self-Reported Computerized Medical History Taking for Acute Chest Pain in the Emergency Department – the Clinical Expert Operating System Chest Pain Danderyd Study (CLEOS-CPDS): Prospective Cohort Study

Journal of Medical Internet Research ◽

10.2196/25493 ◽

2021 ◽

Vol 23 (4) ◽

pp. e25493

Author(s):

Helge Brandberg ◽

Carl Johan Sundberg ◽

Jonas Spaak ◽

Sabine Koch ◽

David Zakim ◽

...

Keyword(s):

Operating System ◽

Cohort Study ◽

Chest Pain ◽

Medical History ◽

Acute Chest Pain ◽

Chief Complaint ◽

History Taking ◽

Sufficient Data ◽

Heart Score ◽

Clinical Expert

Background Chest pain is one of the most common chief complaints in emergency departments (EDs). Collecting an adequate medical history is challenging but essential in order to use recommended risk scores such as the HEART score (based on history, electrocardiogram, age, risk factors, and troponin). Self-reported computerized history taking (CHT) is a novel method to collect structured medical history data directly from the patient through a digital device. CHT is rarely used in clinical practice, and there is a lack of evidence for utility in an acute setting. Objective This substudy of the Clinical Expert Operating System Chest Pain Danderyd Study (CLEOS-CPDS) aimed to evaluate whether patients with acute chest pain can interact effectively with CHT in the ED. Methods Prospective cohort study on self-reported medical histories collected from acute chest pain patients using a CHT program on a tablet. Clinically stable patients aged 18 years and older with a chief complaint of chest pain, fluency in Swedish, and a nondiagnostic electrocardiogram or serum markers for acute coronary syndrome were eligible for inclusion. Patients unable to carry out an interview with CHT (eg, inadequate eyesight, confusion or agitation) were excluded. Effectiveness was assessed as the proportion of patients completing the interview and the time required in order to collect a medical history sufficient for cardiovascular risk stratification according to HEART score. Results During 2017-2018, 500 participants were consecutively enrolled. The age and sex distribution (mean 54.3, SD 17.0 years; 213/500, 42.6% women) was similar to that of the general chest pain population (mean 57.5, SD 19.2 years; 49.6% women). Common reasons for noninclusion were language issues (182/1000, 18.2%), fatigue (158/1000, 15.8%), and inability to use a tablet (152/1000, 15.2%). Sufficient data to calculate HEART score were collected in 70.4% (352/500) of the patients. Key modules for chief complaint, cardiovascular history, and respiratory history were completed by 408 (81.6%), 339 (67.8%), and 291 (58.2%) of the 500 participants, respectively, while 148 (29.6%) completed the entire interview (in all 14 modules). Factors associated with completeness were age 18-69 years (all key modules: Ps<.001), male sex (cardiovascular: P=.04), active workers (all key modules: Ps<.005), not arriving by ambulance (chief complaint: P=.03; cardiovascular: P=.045), and ongoing chest pain (complete interview: P=.002). The median time to collect HEART score data was 23 (IQR 18-31) minutes and to complete an interview was 64 (IQR 53-77) minutes. The main reasons for discontinuing the interview prior to completion (n=352) were discharge from the ED (101, 28.7%) and tiredness (95, 27.0%). Conclusions A majority of patients with acute chest pain can interact effectively with CHT on a tablet in the ED to provide sufficient data for risk stratification with a well-established risk score. The utility was somewhat lower in patients 70 years and older, in patients arriving by ambulance, and in patients without ongoing chest pain. Further studies are warranted to assess whether CHT can contribute to improved management and prognosis in this large patient group. Trial Registration ClinicalTrials.gov NCT03439449; https://clinicaltrials.gov/ct2/show/NCT03439449 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2019-031871

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User Experience of Self-Reported Computerized Medical History Taking for Acute Chest Pain in the Clinical Expert Operating System - Chest Pain Danderyd Study (CLEOS-CPDS): Interview Study Among Patients (Preprint)

10.2196/preprints.30190 ◽

2021 ◽

Author(s):

Kay Sundberg ◽

Athena Adeli ◽

Helge Brandberg ◽

Jonas Spaak ◽

Sabine Koch ◽

...

Keyword(s):

Operating System ◽

Chest Pain ◽

Medical History ◽

User Experience ◽

Acute Chest Pain ◽

Medical History Taking ◽

History Taking ◽

Clinical Context ◽

Interview Guide ◽

Clinical Expert

BACKGROUND Chest pain is one of the most common complaints in emergency departments (EDs). The effectiveness of care for patients with chest pain requires that individual circumstances and the complexity of the patient's clinical issues are determined by medical history taking. The knowledge base for history taking and for interpreting the clinical significance of the information collected can be formalized by software to enable computerized history taking (CHT) directly from patients and subsequently reporting the findings promptly to physicians. The adoption of CHT in clinical practice depends, among other issues, on reactions and attitudes to the technology from patients and their belief that the technology will have benefits for their medical care. OBJECTIVE The objective of this study was to explore the user experience of the self-reported CHT program CLEOS (Clinical Expert Operating System) in the setting of patients attending an ED for acute chest pain. METHODS This qualitative interview study is part of the ongoing CLEOS-Chest Pain Danderyd Study (CLEOS-CPDS), at a cardiology ED. A subset (n=84) of the larger sample who had taken part in self-reported history taking by the CLEOS program during waiting times at the ED were contacted by telephone and n=54 (64%) accepted participation. An interview guide with open-ended questions developed for this study was used. The text was analyzed using conventional content analysis in a deductive way by using the headings in the interview guide. RESULTS Six categories emerged: Clinical context, Individual context, Time aspect, Acceptability of the program, Usability of the program, and Perceptions of usefulness in a clinical context. A majority of the patients thought CLEOS had worked well. Patients also appreciated the opportunities, of interacting with the program and contributing to information about their own health while waiting for care. The program was generally perceived as easy to use and that the questions were mostly seen as relevant and straight forward. Many patients were of the opinion, however, that too many questions were asked and sometimes they mentioned there was insufficient time for responding to them. Some had found it difficult to find the strength to answer all the questions due to their condition. CONCLUSIONS The patients’ experience of the CLEOS program at a cardiology ED reflects an overall positive attitude. The CLEOS program was by some perceived as extensive, although most found the program user-friendly. Despite the busy ED environment, patients were highly motivated and felt that the program would be helpful in leading to a correct diagnosis. These findings suggest an important role for patient-entered CHT programs such as CLEOS in the setting of an ED from the perspective of the patients. CLINICALTRIAL ClinicalTrials.gov NCT03439449

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A prospective cohort study of self-reported computerised medical history taking for acute chest pain: protocol of the CLEOS-Chest Pain Danderyd Study (CLEOS-CPDS)

BMJ Open ◽

10.1136/bmjopen-2019-031871 ◽

2020 ◽

Vol 10 (1) ◽

pp. e031871

Author(s):

Helge Brandberg ◽

Thomas Kahan ◽

Jonas Spaak ◽

Kay Sundberg ◽

Sabine Koch ◽

...

Keyword(s):

Cohort Study ◽

Chest Pain ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Acute Chest Pain ◽

Risk Scores ◽

History Taking ◽

Link Type ◽

Medical Histories ◽

The Impact

IntroductionManagement of acute chest pain focuses on diagnosis or safe rule-out of an acute coronary syndrome (ACS). We aim to determine the additional value of self-reported computerised history taking (CHT).Methods and analysisProspective cohort study design with self-reported, medical histories collected by a CHT programme (Clinical Expert Operating System, CLEOS) using a tablet. Women and men presenting with acute chest pain to the emergency department at Danderyd University Hospital (Stockholm, Sweden) are eligible. CHT will be compared with standard history taking for completeness of data required to calculate ACS risk scores such as History, ECG, Age, Risk factors and Troponin (HEART), Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI). Clinical outcomes will be extracted from hospital electronic health records and national registries. The CLEOS-Chest Pain Danderyd Study project includes (1) a feasibility study of CHT, (2) a validation study of CHT as compared with standard history taking, (3) a paired diagnostic accuracy study using data from CHT and established risk scores, (4) a clinical utility study to evaluate the impact of CHT on the management of chest pain and the use of resources, and (5) data mining, aiming to generate an improved risk score for ACS. Primary outcomes will be analysed after 1000 patients, but to allow for subgroup analysis, the study intends to recruit 2000 or more patients. This ongoing project may lead to new and more effective ways for collecting thorough, accurate medical histories with important implications for clinical practice.Ethics and disseminationThis study has been reviewed and approved by the Stockholm Regional Ethical Committee (now Swedish Ethical Review Authority). Results will be published, regardless of the outcome, in peer-reviewed international scientific journals.Trial registration numberThis study is registered athttps://www.clinicaltrials.gov(unique identifier:NCT03439449).

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Acute chest pain — identification of patients at low risk for coronary events. The impact of symptoms, medical history and risk factors

Wiener klinische Wochenschrift ◽

10.1007/bf03040701 ◽

2004 ◽

Vol 116 (3) ◽

pp. 83-89 ◽

Cited By ~ 7

Author(s):

Martin Schillinger ◽

Gottfried Sodeck ◽

Giora Meron ◽

Karin Janata ◽

Mariam Nikfardjam ◽

...

Keyword(s):

Risk Factors ◽

Chest Pain ◽

Medical History ◽

Acute Chest Pain ◽

Low Risk ◽

Coronary Events ◽

The Impact

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Clinical Assessment Compared To Modified HEART Score in the Assessment of Acute Chest Pain

Heart Lung and Circulation ◽

10.1016/j.hlc.2019.06.363 ◽

2019 ◽

Vol 28 ◽

pp. S291

Author(s):

S. Cheruvu ◽

J. Qin ◽

M. Parkinson ◽

C. Said ◽

P. Bamford ◽

...

Keyword(s):

Chest Pain ◽

Clinical Assessment ◽

Acute Chest Pain ◽

Heart Score

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Rationale and design of a cohort study evaluating triage of acute chest pain in out-of-hours primary care in the Netherlands (TRACE)

Primary Health Care Research & Development ◽

10.1017/s1463423620000122 ◽

2020 ◽

Vol 21 ◽

Author(s):

Amy Manten ◽

Cuny J.J. Cuijpers ◽

Remco Rietveld ◽

Emma Groot ◽

Freek van de Graaf ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Chest Pain ◽

The Netherlands ◽

Clinical Outcomes ◽

Acute Chest Pain ◽

Urgent Care ◽

Triage System ◽

Out Of Hours ◽

Coronary Syndrome

Abstract The aims of this study are (1) to evaluate the performance of current triage for chest pain; (2) to describe the case mix of patients undergoing triage for chest pain; and (3) to identify opportunities to improve performance of current Dutch triage system for chest pain. Chest pain is a common symptom, and identifying patients with chest pain that require urgent care can be quite challenging. Making the correct assessment is even harder during telephone triage. Temporal trends show that the referral threshold has lowered over time, resulting in overcrowding of first responders and emergency services. While various stakeholders advocate for a more efficient triage system, careful evaluation of the performance of the current triage in primary care is lacking. TRiage of Acute Chest pain Evaluation in primary care (TRACE) is a large cohort study designed to describe the current Dutch triage system for chest pain and subsequently evaluate triage performance in regard to clinical outcomes. The study consists of consecutive patients who contacted the out-of-hours primary care facility with chest pain in the region of Alkmaar, the Netherlands, in 2017, with follow-up for clinical outcomes out to August 2019. The primary outcome of interest is ‘major event’, which is defined as the occurrence of death from any cause, acute coronary syndrome, urgent coronary revascularization, or other high-risk diagnoses in which delay is inadmissible and hospitalization is necessary. We will evaluate the performance of the triage system by assessing the ability of the triage system to correctly classify patients regarding urgency (accuracy), the proportion of safe actions following triage (safety) as well as rightfully deployed ambulances (efficacy). TRACE is designed to describe the current Dutch triage system for chest pain in primary care and to subsequently evaluate triage performance in regard to clinical outcomes.

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The prognostic value of HEART score in patients with cocaine associated chest pain: An age-and-sex matched cohort study

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2020.08.074 ◽

2020 ◽

Cited By ~ 2

Author(s):

Ziad Faramand ◽

Christian Martin-Gill ◽

Stephanie O. Frisch ◽

Clifton Callaway ◽

Salah Al-Zaiti

Keyword(s):

Cohort Study ◽

Chest Pain ◽

Prognostic Value ◽

Matched Cohort ◽

Matched Cohort Study ◽

Heart Score ◽

Age And Sex

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COMPARATIVE ANALYSIS OF VARIOUS RISK ASSESSMENT SCORES FOR LOW RISK ACUTE CORONARY SYNDROME IN AN INDIAN SCENARIO – AN ED BASED OBSERVATIONAL STUDY.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i11.746 ◽

2019 ◽

Vol 3 (11) ◽

Author(s):

Zahid Shaikh ◽

V. S. Shinde ◽

Sumalya Tripathi ◽

Dhiraj Jadhav ◽

Ishan Lamba ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Tertiary Care ◽

Acute Chest Pain ◽

Industrial Area ◽

Low Risk ◽

Cardiac Biomarkers ◽

Assessment Scores ◽

Heart Score ◽

Coronary Syndrome

Chest pain is one of the most common presentation to emergency department (ED). The misdiagnosis or over-diagnosis of patients with acute chest pain can be associated with serious clinical events or is time-consuming and this places a heavy burden on overcrowded and resource constraint ED. To help overcome this issue various scores are formed to rule out acute coronary syndrome (ACS) in these patients. Those who do not meet the criteria of high risk ACS like raised cardiac biomarkers, ECG changes, etc are labeled as low risk ACS. These patients form the majority of patients. A multitude of risk score have been formulated to predict the outcome and risk stratify patients with chest pain. Our objective was to evaluate the utility of these score in Indian setting in low risk ACS patients. We studied the various risk prediction score of 100 patients presenting to the ED of tertiary care teaching institute in an urban industrial area with low risk ACS. The scores that were calculated included HEART, TIMI, ADAPT, GRACE, NACPR and EDACS. Of all the scores only the HEART score correlated well with identifying those who required further testing. Taking a score of less than 3 as a marker of low risk ACS we get a sensitivity of 95.83% (95CI - 89.67% to 98.85%) and specificity of 100%. The PPV is 100% and accuracy of 96%. All other scores were either not specific enough or had limited utility. Keywords: Low risk ACS, ACS, HEART, TIMI, ADAPT, GRACE, NACPR, EDACS

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