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    PRe-hospital Evaluation of Sensitive TrOponin (PRESTO) Study: multicentre prospective diagnostic accuracy study protocol

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    Author
    Alghamdi, Abdulrhman cc
    Cook, Eloïse cc
    Carlton, Edward
    Siriwardena, Aloysius cc
    Hann, Mark
    Thompson, Alexander
    Foulkes, Angela
    Phillips, John
    Cooper, Jamie
    Bell, Steve cc
    Kirby, Kim cc
    Rosser, Andy
    Body, Richard
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    Keyword
    Emergency Medical Services
    Myocardial Infarction
    Acute Coronary Syndrome
    Emergency Care
    Pre-hospital Care
    Journal title
    BMJ Open
    
    Metadata
    Show full item record
    URI
    http://hdl.handle.net/20.500.12417/796
    DOI
    10.1136/bmjopen-2019-032834
    Abstract
    Introduction Within the UK, chest pain is one of the most common reasons for emergency (999) ambulance calls and the most common reason for emergency hospital admission. Diagnosing acute coronary syndromes (ACS) in a patient with chest pain in the prehospital setting by a paramedic is challenging. The Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision rule is a validated tool used in the emergency department (ED) to stratify patients with suspected ACS following a single blood test. We are seeking to evaluate the diagnostic accuracy of the T-MACS decision aid algorithm to ‘rule out’ ACS when used in the prehospital environment with point-of-care troponin assays. If successful, this could allow paramedics to immediately rule out ACS for patients in the ‘very low risk’ group and avoid the need for transport to the ED, while also risk stratifying other patients using a single blood sample taken in the prehospital setting. Methods and analysis We will recruit patients who call emergency (999) ambulance services where the responding paramedic suspects cardiac chest pain. The data required to apply T-MACS will be prospectively recorded by paramedics who are responding to each patient. Paramedics will be required to draw a venous blood sample at the time of arrival to the patient. Blood samples will later be tested in batches for cardiac troponin, using commercially available troponin assays. The primary outcome will be a diagnosis of acute myocardial infarction, established at the time of initial hospital admission. The secondary outcomes will include any major adverse cardiac events within 30 days of enrolment. Ethics and dissemination The study obtained approval from the National Research Ethics Service (reference: 18/ES/0101) and the Health Research Authority. We will publish our findings in a high impact general medical journal.Abstract, URL This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI: 10.1136/bmjopen-2019-032834
    ae974a485f413a2113503eed53cd6c53
    10.1136/bmjopen-2019-032834
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    Publications - West Midlands Ambulance Service
    Publications - South Western Ambulance Service
    Publications - North West Ambulance Service

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