Background Improving telephone triage for patients with chest pain has been identified as a national research priority. However, there is a lack of strong evidence to define the life-threatening conditions (LTCs) that telephone triage ought to identify. Therefore, we aimed to build consensus for the LTCs associated with chest pain that ought to be identified during telephone triage for emergency calls. Methods We conducted a Delphi study in three rounds. Twenty experts in pre-hospital care and emergency medicine experience from the UK were invited to participate. In round I, experts were asked to list all LTCs that would require priority 1, 2, and 4 ambulance responses. Round II was a ranking evaluation, and round III was a consensus round. Consensus level was predefined at ≥ 70%. Results A total of 15 participants responded to round one and 10 to rounds two and three. Of 185 conditions initially identified by the experts, 26 reached consensus in the final round. Ten conditions met consensus for requiring priority 1 response: oesophageal perforation/rupture; ST elevation myocardial infarction; non-ST elevation myocardial infarction with clinical compromise (defined, also by consensus, as oxygen saturation <90%, heart rate <40/minute or systolic blood pressure <90mmHg); acute heart failure; cardiac tamponade; life-threatening asthma; cardiac arrest; tension pneumothorax and massive pulmonary embolism. An additional six conditions met consensus for priority 2 response, and three for priority 4 response. Conclusion Using expert consensus, we have defined the LTCs that may present with chest pain, which ought to receive a high-priority ambulance response. This list of conditions can now form a composite primary outcome for future studies to derive and validate clinical prediction models that will optimise telephone triage for patients with a primary complaint of chest pain.

中文翻译：

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PP14 向增强 EMS 电话分流治疗胸痛迈出的一步：一项德尔福研究，以确定必须确定的危及生命的状况

背景 改善胸痛患者的电话分诊已被确定为国家研究重点。然而，缺乏强有力的证据来定义电话分类应该识别的危及生命的条件 (LTC)。因此，我们的目标是就与胸痛相关的 LTC 达成共识，这些 LTC 应该在紧急呼叫的电话分类中被识别出来。方法 我们进行了三轮德尔菲研究。邀请了来自英国的20位院前护理和急诊医学经验专家参加。在第一轮中，专家被要求列出所有需要优先级 1、2 和 4 救护车响应的 LTC。第二轮是排名评估，第三轮是共识轮。共识水平预先设定为≥ 70%。结果 共有 15 名参与者对第一轮和第 10 轮对第二轮和第三轮做出了回应。专家们初步确定的 185 个条件中，有 26 个在最后一轮达成共识。10 个条件符合要求优先 1 响应的共识：食管穿孔/破裂；ST 抬高心肌梗死; 伴有临床损害的非 ST 段抬高心肌梗塞（也由共识定义为氧饱和度 <90%、心率 <40/分钟或收缩压 <90mmHg）；急性心力衰竭; 心脏压塞; 危及生命的哮喘；心脏骤停; 张力性气胸和大面积肺栓塞。另外六个条件符合优先级 2 响应的共识，三个条件符合优先级 4 响应。结论 使用专家共识，我们定义了可能出现胸痛的 LTC，应该得到高优先级的救护车响应。这个条件列表现在可以形成一个复合的主要结果，用于未来的研究，以得出和验证临床预测模型，这些模型将优化对主要抱怨胸痛的患者的电话分诊。