Triage Rule-out Using Sensitive Troponin (TRUST): Study of early risk-stratification of suspected cardiac chest pain and initiation of 1-hour high-sensitivity troponin testing in very low and low-risk Emergency Department patients

Not Applicable

Completed

Conditions: Chest pain
Signs and Symptoms
Chest pain, unspecified

Registration Number: ISRCTN21109279

Lead Sponsor: Poole Hospital NHS Foundation Trust (UK)

Brief Summary: Not available

Detailed Description: Not available

Recruitment & Eligibility

Status: Completed

Sex: All

Target Recruitment: 1200

Inclusion Criteria

1. Consenting adults (age 18-79) presenting to the Emergency Department with at least 5 minutes of chest pain (or discomfort) suggestive of acute coronary syndromes for whom attending clinicians are planning further assessment with delayed (6 hour) troponin testing
2. Possible symptoms suggestive of acute coronary syndromes include acute chest, epigastric, neck, jaw or arm pain; or chest discomfort or pressure without an apparent non-cardiac source.

Exclusion Criteria

1. Age <18 or >79
2. Patients with ischaemic initial electrocardiogram (ECG) or ST-elevation infarct
3. Atypical symptoms (fatigue, nausea, vomiting, diaphoresis, faintness and back pain) in the absence of chest pain or discomfort
4. An alternative cause of chest pain is suspected at presentation (e.g. pulmonary embolus, dissection, pneumothorax)
5. Refusal of patient consent
6. Renal failure requiring dialysis
7. Unable to speak English language
8. Follow-up will be impossible
9. Trauma with suspicion of myocardial contusion
10. Another medical condition that necessitates hospital admission
11. Prisoners
12. Pregnancy

Study & Design

Study Type: Observational

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
The proportion of very low or low-risk patients (established using the modified Goldman risk score) with a troponin blood result of <14ng/l at 1 hour with no major adverse cardiac events at 30 days after initial presentation (including initial hospital attendance)

Secondary Outcome Measures

Name	Time	Method
1. The accuracy of Emergency Department nursing staff risk assessment using the modified Goldman risk score to determine very low/low clinical risk in comparison with doctor risk assessment using the same score<br>2. Patient opinion as to whether a prolonged period of admission and observation is required for reassurance in this low-risk group