JMIR Publications

ABSTRACT

Background:

Chest pain is one of the most common chief complaints in emergency departments (EDs). Collecting an adequate medical history is challenging but essential in order to use recommended risk scores such as HEART score (based on History, ECG, Age, Risk factors and Troponin). Self-reported computerized history taking (CHT) is a novel method to collect structured medical history data directly from the patient through a digital device. CHT is rarely used in clinical practice and there is a lack of evidence for utility in an acute setting.

Objective:

The present sub-study of the Clinical Expert Operating System Chest Pain Danderyd Study (CLEOS-CPDS) aimed to evaluate whether patients with acute chest pain can interact effectively with CHT in the ED.

Methods:

Prospective cohort study on self-reported, medical histories collected from acute chest pain patients using a CHT program on a tablet. Clinically stable patients with a chief complaint of chest pain, aged 18 years and above, with fluency in Swedish, a non-diagnostic ECG or serum markers for acute coronary syndrome were eligible for inclusion. Patients unable to carry out an interview with CHT (e.g., inadequate eyesight, confusion or agitation) were excluded.

Results:

During 2017-2018, 500 participants were consecutively enrolled. Age and sex distribution (54.3±17.0 years, 43% women) was similar to the general chest pain population (57.5±19.2 years, 50% women). Common reasons for non-inclusion were language issues (18%), fatigue (16%) or inability to use a tablet (15%). Sufficient data to calculate HEART score were collected in 70% of the patients. Key modules for chief complaint (CC), cardiovascular (CV) and respiratory history were completed by 82%, 68% and 58% of the participants, respectively, while 30% completed the entire interview (in all 14 modules). Factors associated with completeness were age 18-69 years (all key modules: P<.001), male sex (CV: P=.046), active workers (all key modules: P<.04), not arriving by ambulance (CC: P=.03; CV: P=.045), and ongoing chest pain (complete interview: P=.002). The median time to collect HEART score data was 23 (18-31) min and a complete interview 64 (53-77) min. Main reasons for discontinuing the interview prior completion (n=352) were discharge from ED (29%) and tiredness (27%).

Conclusions:

A majority of patients with acute chest pain can interact effectively with CHT on a tablet in the ED. The utility was somewhat lower in patients 70 years and above, in patients arriving by ambulance, and in patients without ongoing chest pain. CHT may contribute to safer and more efficient management with improved risk stratification in this large patient group. Clinical Trial: ClinicalTrials.gov NCT03439449