Risk stratification of chest pain patients in the emergency department by a nurse utilizing a point of care protocol

Eur J Emerg Med. 2008 Feb;15(1):9-15. doi: 10.1097/MEJ.0b013e3282aa4045.


Objective: Risk stratification of patients with ischaemic type chest pain assessed in the emergency department utilizing a point of care (POC) protocol.

Methods: Patient demographics, cardiac biomarkers, management and follow-up at 6 months were reviewed for patients seen over 20 months.

Results: Out of 546 patients, 351 (64%) were admitted. The diagnoses after admission were confirmed as acute myocardial infarction in 59 patients and unstable angina, (cTroponin T<0.09 ng/ml) in 92 patients. The c-statistic of the receiver operating curves for myocardial infarction (myocardial infarction, cTroponinT at 12 h >0.09 ng/ml) as determined by the POC assay was cTroponin I=0.884, CK-MB=0.883, myoglobin=0.845 and beta-type natriuretic peptide (BNP)=0.755. The c-statistic for the same sample assessed by the hospital laboratory was cTroponin T=0.893: for CK-MB within 12 h of admission it was 0.918; the 12 h cTroponin T was 0.982 and within 24 h of admission NT pro-BNP was 0.789. POC BNP in patients admitted was 68 ng/l (median) vs. 24 ng/l (median) for those not admitted, (P<0.001). POC BNP for patients admitted with unstable angina (12 h cTroponin T <0.09 ng/ml) was 47 ng/l (median, P<0.001). At 6 months, 14 patients had died; five during admission, two within 30 days and seven up to 6 months. During admission two died from heart failure, two with respiratory tract infection and one from carcinoma. Of those not admitted one had died from asbestosis.

Conclusion: Risk stratification by a specialist nurse utilizing a POC protocol is an appropriate means of assessing patients with chest pain.

MeSH terms

  • Adult
  • Aged
  • Angina, Unstable / complications
  • Angina, Unstable / diagnosis*
  • Biomarkers / blood
  • Chest Pain / etiology*
  • Emergency Nursing*
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / diagnosis*
  • Natriuretic Peptide, Brain / blood
  • Nurses
  • Point-of-Care Systems*
  • ROC Curve
  • Retrospective Studies
  • Triage / methods*
  • Troponin I / blood
  • Troponin T / blood


  • Biomarkers
  • Troponin I
  • Troponin T
  • Natriuretic Peptide, Brain