Enhancing Pre-hospital Chest Pain Telephone-triage
Research type
Research Study
Full title
Enhancing Pre-hospital Chest Pain Telephone-triage Using a Prediction Model
IRAS ID
277778
Contact name
Richard Body
Contact email
Sponsor organisation
University of Manchester
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
1 years, 6 months, 19 days
Research summary
Research Summary
Chest pain, which is one of the main symptoms of Acute Coronary Syndrome (ACS), is one of the most common reasons to use ambulance services and EDs admission. ACS patients usually present with chest pain, while the majority of chest pain patients that were transported by ambulance and admitted to EDs were diagnosed with non-cardiac disease. Moreover, the prevalence of having the ACS is less than 20% among patients who are admitted for suspicion of ACS.
With the current clinical guidelines for emergency medical services (EMS), it is hard to rule in or rule out ACS by telephone-triage. Consequently, there is a need to enhance pre-hospital telephone-triage using prediction models as it showed a promising result. Implementation of a prediction model would improve pre-hospital resources usage, identify ACS patients earlier, and reduce un-necessarily EDs admission.
In this study, we will derive and validate a prediction model for use in the pre-hospital setting. A retrospective observational cohort study will be used to collect data of chest patients from North West Ambulance Services (NWAS) EMS dispatch system. We will determine the outcome of patients by linking the data from the receiving hospital.
Summary of Results
Thank you We would like to thank the organisations that supported this research and the patients whose routinely collected healthcare information made this study possible.
What was this study about?
Chest pain is one of the most common reasons for calling 999. Some people with chest pain have serious conditions that need an immediate ambulance response, but many do not.
At present, ambulance call handlers use standard triage systems to decide how quickly an ambulance should be sent. This study aimed to develop a new prediction model that could help identify people with chest pain who were most likely to have a serious, life-threatening condition.
The long-term goal was to understand whether telephone triage for chest pain could be made more accurate while continuing to protect patient safety.
Who took part?
The study used routinely collected information from adults who called the North West Ambulance Service with chest pain between 2018 and 2019 and were subsequently treated at Manchester University NHS Foundation Trust.
No patients were contacted directly and no additional procedures or tests were carried out as part of the research.
What happened during the study?
Researchers linked ambulance service records with hospital records to identify which patients were ultimately diagnosed with serious conditions.
The study team successfully collected, linked and prepared the data for analysis. Most of the planned statistical analyses were completed and stored within the University of Manchester's secure Data Safe Haven, which is a protected environment used for research involving confidential information.
What were the results?
Unfortunately, the study could not be completed.
In 2023, the University of Manchester experienced a major cyberattack. As a precaution, access to the Data Safe Haven was suspended for an extended period. This occurred shortly before the final planned analysis was carried out.
When access was later restored, researchers confirmed that all patient data had been securely destroyed in accordance with the study approvals. However, some of the analysis output files could not be located. As a result, the remaining analyses could not be completed and the final study results could not be recovered.
Because of this, it is not possible to report whether the prediction model would have improved telephone triage for chest pain.
Were there any risks to patients?
No.
This study used information that had already been collected as part of routine healthcare. Patient care was not affected by the study ending early. No concerns about patient confidentiality or data security relating to study participants were identified.
How has this study helped researchers?
Although the study did not produce its planned final results, it highlighted some of the challenges involved in conducting large studies that rely on linked healthcare data and secure research environments.
The work also demonstrated that large-scale linkage of ambulance service and hospital records is possible and may support future research into emergency telephone triage.
What happens next?
The research team has concluded that it is no longer feasible to complete the study and the study has therefore been closed.
No further analyses are planned because the information required to complete the remaining work is no longer available.REC name
North West - Greater Manchester East Research Ethics Committee
REC reference
21/NW/0123
Date of REC Opinion
27 Apr 2021
REC opinion
Favourable Opinion