Background: Emergency medicine doctors should take care of patients with a wide range of illnesses at various emergency levels from non-urgent level to that requiring immediate medical attention. Among those, cardiovascular emergencies are not so common but life-threatening disorders that must be recognized immediately to avoid delay in treatment and to minimize morbidity and mortality. Our goal is to investigate the prevalence of cardiovascular emergencies and a role for the initial nurse triage system in emergency clinic of a Japanese teaching general hospital.
Methods: We examined all patients who first visited our emergency clinic by walk-in or ambulance between April 1, 2016 and March 31, 2017, and then analyzed the relationship between cardiovascular emergencies and their initial triage levels by nurses using modified CTAS.
Results: Of 9912 patients, 2683 came by ambulance, the remaining 6229 by walk-in. Cardiovascular emergencies were 114 cases (1.2%) that consisted of 39 with arrhythmias (including 17 atrial fibrillation, 4 supraventricular tachycardia and 4 complete atrioventricular block), 21 myocardial infarction (13 STEMI, and 8 non-STEMI), 20 acute heart failure, 9 pulmonary thromboembolism, 6 aortic dissection, 4 unstable angina, 4 pericarditis, 2 deep vein thrombosis, 2 aortic stenosis, 1 abdominal aortic aneurysm, 1 acute myocarditis and 1 Takotsubo cardiomyopathy. Half of them were urgent (level 3), and other quarters were emergent (level 2) and less urgent (level 4), respectively. One case needed resuscitation (level 1), and there was no non-urgent level (level 5). The emergency level was significantly higher in STEMI (level 1[8%], level 2 [69%], level 3 [23%], level 4 [0%]), than in non-STEMI (level 1[0%], level 2 [25%], level 3 [50%], level 4 [25%]). There was no hospital death in those patients.
Conclusions: Only 1.2% of all first visitors were cardiovascular emergencies. Although the initial nurse triage system helped to lead a correct diagnosis and treatment without significant delay, not a few cases were at less-urgent level with minor signs and symptoms that have little clues for severe cardiovascular disorders. Improving skills of triage nurses and information sharing with emergency medical specialists are crucial.