Standardizing Emergency Work-ups Around Risk Data

Completed

• Conditions: Chest Pain; Acute Coronary Syndrome; Risk Reduction

• Registration Number: NCT03286179
• Lead Sponsor: Kaiser Permanente

Brief Summary

Chest pain is the second leading reason for emergency department (ED) visits in the United States. Resource utilization for this ED subpopulation is particularly high, in part due to a dearth of accepted standardized clinical approaches and general overestimation of risk on the part of both providers and patients. This prospective observational cohort study seeks to address this issue by providing externally validated risk scores for major adverse cardiac events using a web-based clinical decision support platform (RISTRA) embedded within the electronic health record at 13 Kaiser Permanente Northern California (KPNC) EDs over a 12-month period. The decision support will provide risk estimates specific to the KPNC patient population. This studies hypothesis is that the provision of more accurate risk estimation for major adverse cardiac events will improve informed decision making by both providers and patients, resulting in less provocative testing and lower ED lengths of stay amongst low risk patients, as well as improving medical management among non-low risk patients and decreasing future rates of major adverse cardiac events.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2017-09-13
• Study First Submitted QC: 2017-09-13
• Study First Posted: 2017-09-18
• Study Start: 2018-07-01
• Primary Completion: 2019-12-31
• Study Completion: 2020-06-01
• Status Verified: 2020-08
• Last Update Submitted: 2020-08-11
• Last Update Posted: 2020-08-12

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 13419

Inclusion Criteria

• Emergency department chief complaint of chest pain or chest discomfort
• Clinical concern for possible cardiac ischemia

Exclusion Criteria

Not provided

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Major adverse cardiac event (MACE)	12 months	A composite outcome of either acute myocardial infarction, cardiac arrest, malignant arrhythmia, cardiac-related mortality

Secondary Outcome Measures

Name	Time	Method
Provocative and anatomic cardiac testing rates	12 months	Treadmill stress test, myocardial perfusion imaging, stress echocardiography, CT coronary angiography, catheter-based coronary angiography
Emergency department length of stay	12 months	Total hours spent in the emergency department among study eligible patients
Hospital admission rate	12 months	Percentage of hospital admissions among study eligible patients

Trial Locations

Locations (12)

Kaiser Permanente Antioch Emergency Department; 🇺🇸 Antioch, California, United States

Kaiser Permanente Fremont Emergency Department; 🇺🇸 Fremont, California, United States

Kaiser Permanente Oakland Emergency Department; 🇺🇸 Oakland, California, United States

Kaiser Permanente Richmond Emergency Department; 🇺🇸 Richmond, California, United States

Kaiser Permanente Roseville Emergency Department; 🇺🇸 Roseville, California, United States

Kaiser Permanente South Sacramento Emergency Department; 🇺🇸 Sacramento, California, United States

Kaiser Permanente Sacramento Emergency Department; 🇺🇸 Sacramento, California, United States

Kaiser Permanente San Francisco Emergency Department; 🇺🇸 San Francisco, California, United States

Kaiser Permanente San Leandro Emergency Department; 🇺🇸 San Leandro, California, United States

Kaiser Permanente San Rafael Emergency Department; 🇺🇸 San Rafael, California, United States

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