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Master Thesis

Évaluation de l’utilisation du protocole d’exclusion rapide dans la prise en charge des douleurs thoraciques suspectes de syndrome coronarien aigu : évaluation des pratiques aux Urgences Générales du Centre Hospitalier d’Arcachon

Abstract : Introduction: in 2019, a medical study showed that the diagnostic protocol used for suspected acute coronary syndrome (ACS) in the Emergency Department (ED) of Arcachon Hospital did not accurately follow the guidelines published by the European Society of Cardiology (ESC) in 2015. Our prospective pre/post-implementation study sought to evaluate the feasibility of ESC recommended fast diagnostic protocols using the 0/1-hour algorithm in patients with suspected ACS. Methods: this was a prospective single-centre study of all adult patients with ACS at Arcachon Hospital between the 1st of March 2019 and the 30th of June 2019. Implementation of the 0/1- hour protocol was monitored and assessed for 2 months after staff training. The primary endpoint was the length of time to obtain a second diagnostic high-sensitivity troponin T level. Results: one hundred and ten patients were included with 41 patients (37%) who presented with chest pain for less than 3 hours prior to ED admission. A 48% reduction of the troponin analysis time was observed when compared to the same period in 2018 (28 versus 58 minutes). This improvement was largely due to the reduction of the time taken to obtain the second diagnostic high-sensitivity troponin T level (median time of 179 versus 300 minutes). A reduction of the length of the ED stay was observed (median time of 270 versus 379 minutes). However, the length of time until an electrocardiography and blood samples were performed was unchanged. Conclusion: our study showed a quicker diagnosis of myocardial infarction with the implementation of the 0/1-hour algorithm in patients presenting with suspected ACS. Considering that new guidelines ESC guidelines were published in 2020, a short time after the completion of this study, a further, larger, prospective, multi-centre study is warranted to assess the feasibility and efficacy of these guidelines.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03120564
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Submitted on : Monday, January 25, 2021 - 3:56:30 PM
Last modification on : Wednesday, February 3, 2021 - 3:11:14 AM
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Anthony Uliana. Évaluation de l’utilisation du protocole d’exclusion rapide dans la prise en charge des douleurs thoraciques suspectes de syndrome coronarien aigu : évaluation des pratiques aux Urgences Générales du Centre Hospitalier d’Arcachon. Médecine humaine et pathologie. 2020. ⟨dumas-03120564⟩

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