Application of synthetic patient data in the assessment of rapid rule-out protocols usingPoint-of-Care testing during chest pain diagnosis in a UK emergency department

S Robinson, F FitzGibbon, J Eatock, T Hunniford, D Dixon, BJ Meenan

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Clinical research is often delayed by the lack of data and the need for ethical approval. We suggest that this need could be initially satisfied by synthetic data that has the same characteristics as those from patient records. The generation of this data requires some domain knowledge to ensure appropriate data management. As an exemplar of this concept we generate patients presenting with undifferentiated chest pain at Emergency Department (ED). Their diagnosis uses biochemical markers indicative of myocardial cell damage. Efficient diagnosis is paramount and a number of different competing protocols have been advocated. Analysis of resulting data shows that while the measurement of cardiac markers may not register above a cut-off value that the time differentiated rule-out protocols are valuable indicators of disease. We therefore demonstrate both concept and value of the use of synthetic data that would have taken years to gather and not have been reproducible or repeatable.
LanguageEnglish
Pages163-170
JournalJournal of Simulation
Volume3
Early online date7 Sep 2009
DOIs
Publication statusE-pub ahead of print - 7 Sep 2009

Fingerprint

Pain
Emergency
Synthetic Data
Testing
Information management
Cells
Domain Knowledge
Data Management
Cardiac
Damage
Cell
Demonstrate
Concepts

Keywords

  • synthetic data
  • point-of-care
  • rule-out
  • chest pain
  • emergency department

Cite this

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title = "Application of synthetic patient data in the assessment of rapid rule-out protocols usingPoint-of-Care testing during chest pain diagnosis in a UK emergency department",
abstract = "Clinical research is often delayed by the lack of data and the need for ethical approval. We suggest that this need could be initially satisfied by synthetic data that has the same characteristics as those from patient records. The generation of this data requires some domain knowledge to ensure appropriate data management. As an exemplar of this concept we generate patients presenting with undifferentiated chest pain at Emergency Department (ED). Their diagnosis uses biochemical markers indicative of myocardial cell damage. Efficient diagnosis is paramount and a number of different competing protocols have been advocated. Analysis of resulting data shows that while the measurement of cardiac markers may not register above a cut-off value that the time differentiated rule-out protocols are valuable indicators of disease. We therefore demonstrate both concept and value of the use of synthetic data that would have taken years to gather and not have been reproducible or repeatable.",
keywords = "synthetic data, point-of-care, rule-out, chest pain, emergency department",
author = "S Robinson and F FitzGibbon and J Eatock and T Hunniford and D Dixon and BJ Meenan",
note = "Reference text: Adams P (2008). Definition of acute myocardial infarction Newcastle Hospitals NHS trust, www.c2c.nhs.uk/media/{\%}7BC8DD3294–4961–4004-A86F-4F7062438F6A{\%}7D.ppt, accessed 29 September 2008. Apple FS et al (2005). Validation of the 99th percentile cutoff independent of assay imprecision (CV) for cardiac troponin monitoring for ruling out myocardial infarction. Clin Chem 51: 2198–2200. Apple FS et al (2003). Plasma 99th percentile reference limits for cardiac troponin and creatine kinase MB mass for use with European society of cardiology/American college of cardiology consensus recommendations. Clin Chem 49(8): 1331–1336. Benger JR, Karlsten R and Eriksson B (2002). Prehospital thrombolysis: Lessons from Sweden and their application to the United Kingdom. Emerg Med J 19: 578–583. Body R (2008). Emergent diagnosis of acute coronary syndromes: Today’s challenges and tomorrow’s possibilities. Resuscitation 78: 13–20. Brendan M et al (2002). Triage of patients with chest pain in the emergency department: A comparative study of physicians’ decisions. Am J Med 112: 95–103. Carley S et al (2002). What’s the point of ST elevation? Emerg Med J 19: 126–128. Collinson PO et al (2006). Comparison of biomarker strategies for rapid rule-out of myocardial infarction in the emergency department using ACC/ESC diagnostic criteria. Ann Clin Biochem 43: 273–280. DeVitaMA et al (2005). Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator. Qual Saf Health Care 14: 326–331. Dunn F, Hughes D, Rocke LGR and McNicholl BP (2006). Are chest pain observation units essential for rapid and effective emergency care in the UK? Emerg Med J 23: 487–488. Dutta P et al (2005). SimCare: A model for studying physician decision making activity. Advances in patient safety: from research to implementation: Programs, Tools, and Products No. 4. Rockville (MD) agency for healthcare research and quality. AHRQ Publication 4(5): 21–24. Fox KF (2005). Investigation and management of chest pain. Heart 91: 105–110. Goodacre S et al (2007). The ESCAPE Multi-Centre evaluation of the role of chest pain units in the NHS. Available at http://www.sdo.nihr.ac.uk, accessed 2007. Goodacre S et al (2005). Which diagnostic tests are the most useful in chest pain unit protocol. BMC Emerg Med 5(6): 1–7. Goodacre S et al (2004). Randomized controlled trial and economic evaluation of a chest pain observation unit compared with routine care. BMJ 328: 254–257. Hamilton AJ et al (2008). Risk stratification of chest pain patients in the emergency department by a nurse utilizing a point of care protocol. Eur J Emerg Med 15: 9–15. Heath SM et al (2003). Nurse intiated thrombolysis in the accident and emergency department. Emerg Med J 20: 418–420. S Robinson et al—Application of synthetic patient data 169 Information Governance Statement of Compliance V6.0. NHS Connecting for Health. IGSOC Documents, available at http://www.connectingforhealth.nhs.uk/systemsandservices/infogov/ igsoc/links, accessed 31 October 2008. NHS National Workforce Projects, available at http://www.healthcareworkforce.nhs.uk/resource_library/latest_re sources/workforce_planning_development_menus.html, accessed 31 October 2008. UK Clinical Research Collaboration (UKCRC) Response to: The Ministry of Justice Consultation on the Use and Sharing of Personal Information in the Public and Private Sector. Office For Strategic Coordination of Health Research. Chairman’s First progress Report, November 2008, HMG, available at http://www.nihr.ac.uk/files/pdfs/oschr_progress_report_18.11.08.pdf, accessed November 2008. Turning Test, Wikipedia, available at http://en.wikipedia.org/wiki/Turing_test, accessed 1 February 2009. International Liaison Committee on Resuscitation (2005). Part 5:Acute coronary syndromes. Resuscitation 67: 249–269. Lattimer V (2004). Reviewing emergency care systems I: Insights from system dynamics modelling. Emerg Med J 21: 685–691. McCabe RM (2008). Using Data Mining to Predict Errors in Chronic Disease Care, in Advances in Patient Safety: New Directions and Alternative Approaches. Agency for Healthcare Research and Quality. McCord J et al (2001). Ninety-minute exclusion of acute myocardial infarction by use of quantitative point of care testing of myoglobin and Troponin I. Circulation 104: 1483–1488. National Institute for Clinical Excellence (NICE) (2002). Guidance on the Use of Drugs for Early Thrombolysis in the Treatment of Acute Myocardial Infarction. London. Ng MS et al (2001). Ninety-minute accelerated critical pathway for chest pain evaluation. Am J Cardiol 88: 611–617. Purchasing and Supply Agency (2006). Three point of care devices for troponin measurement. Evaluation. Report 06020. Rajappan K et al (2005). Usage of troponin in the real world: A lesson for the introduction of biochemical assays. Q J Med 98: 337–342. Turab A, Scrafton J and Andrews R (2006). Near patient testing for cardiac troponin I to reduce hospital stay in patients presenting with chest pain. Br J cardiol (Acute Interv Cardiol) 13: 19–21.",
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Application of synthetic patient data in the assessment of rapid rule-out protocols usingPoint-of-Care testing during chest pain diagnosis in a UK emergency department. / Robinson, S; FitzGibbon, F; Eatock, J; Hunniford, T; Dixon, D; Meenan, BJ.

In: Journal of Simulation, Vol. 3, 07.09.2009, p. 163-170.

Research output: Contribution to journalArticle

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T1 - Application of synthetic patient data in the assessment of rapid rule-out protocols usingPoint-of-Care testing during chest pain diagnosis in a UK emergency department

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AU - FitzGibbon, F

AU - Eatock, J

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Triage of patients with chest pain in the emergency department: A comparative study of physicians’ decisions. Am J Med 112: 95–103. Carley S et al (2002). What’s the point of ST elevation? Emerg Med J 19: 126–128. Collinson PO et al (2006). Comparison of biomarker strategies for rapid rule-out of myocardial infarction in the emergency department using ACC/ESC diagnostic criteria. Ann Clin Biochem 43: 273–280. DeVitaMA et al (2005). Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator. Qual Saf Health Care 14: 326–331. Dunn F, Hughes D, Rocke LGR and McNicholl BP (2006). Are chest pain observation units essential for rapid and effective emergency care in the UK? Emerg Med J 23: 487–488. Dutta P et al (2005). SimCare: A model for studying physician decision making activity. Advances in patient safety: from research to implementation: Programs, Tools, and Products No. 4. Rockville (MD) agency for healthcare research and quality. AHRQ Publication 4(5): 21–24. Fox KF (2005). Investigation and management of chest pain. Heart 91: 105–110. Goodacre S et al (2007). The ESCAPE Multi-Centre evaluation of the role of chest pain units in the NHS. Available at http://www.sdo.nihr.ac.uk, accessed 2007. Goodacre S et al (2005). Which diagnostic tests are the most useful in chest pain unit protocol. BMC Emerg Med 5(6): 1–7. Goodacre S et al (2004). Randomized controlled trial and economic evaluation of a chest pain observation unit compared with routine care. BMJ 328: 254–257. Hamilton AJ et al (2008). Risk stratification of chest pain patients in the emergency department by a nurse utilizing a point of care protocol. Eur J Emerg Med 15: 9–15. Heath SM et al (2003). Nurse intiated thrombolysis in the accident and emergency department. Emerg Med J 20: 418–420. S Robinson et al—Application of synthetic patient data 169 Information Governance Statement of Compliance V6.0. NHS Connecting for Health. IGSOC Documents, available at http://www.connectingforhealth.nhs.uk/systemsandservices/infogov/ igsoc/links, accessed 31 October 2008. NHS National Workforce Projects, available at http://www.healthcareworkforce.nhs.uk/resource_library/latest_re sources/workforce_planning_development_menus.html, accessed 31 October 2008. UK Clinical Research Collaboration (UKCRC) Response to: The Ministry of Justice Consultation on the Use and Sharing of Personal Information in the Public and Private Sector. Office For Strategic Coordination of Health Research. Chairman’s First progress Report, November 2008, HMG, available at http://www.nihr.ac.uk/files/pdfs/oschr_progress_report_18.11.08.pdf, accessed November 2008. Turning Test, Wikipedia, available at http://en.wikipedia.org/wiki/Turing_test, accessed 1 February 2009. International Liaison Committee on Resuscitation (2005). Part 5:Acute coronary syndromes. Resuscitation 67: 249–269. Lattimer V (2004). Reviewing emergency care systems I: Insights from system dynamics modelling. Emerg Med J 21: 685–691. McCabe RM (2008). Using Data Mining to Predict Errors in Chronic Disease Care, in Advances in Patient Safety: New Directions and Alternative Approaches. Agency for Healthcare Research and Quality. McCord J et al (2001). Ninety-minute exclusion of acute myocardial infarction by use of quantitative point of care testing of myoglobin and Troponin I. Circulation 104: 1483–1488. National Institute for Clinical Excellence (NICE) (2002). Guidance on the Use of Drugs for Early Thrombolysis in the Treatment of Acute Myocardial Infarction. London. Ng MS et al (2001). Ninety-minute accelerated critical pathway for chest pain evaluation. Am J Cardiol 88: 611–617. Purchasing and Supply Agency (2006). Three point of care devices for troponin measurement. Evaluation. Report 06020. Rajappan K et al (2005). Usage of troponin in the real world: A lesson for the introduction of biochemical assays. Q J Med 98: 337–342. Turab A, Scrafton J and Andrews R (2006). Near patient testing for cardiac troponin I to reduce hospital stay in patients presenting with chest pain. Br J cardiol (Acute Interv Cardiol) 13: 19–21.

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AB - Clinical research is often delayed by the lack of data and the need for ethical approval. We suggest that this need could be initially satisfied by synthetic data that has the same characteristics as those from patient records. The generation of this data requires some domain knowledge to ensure appropriate data management. As an exemplar of this concept we generate patients presenting with undifferentiated chest pain at Emergency Department (ED). Their diagnosis uses biochemical markers indicative of myocardial cell damage. Efficient diagnosis is paramount and a number of different competing protocols have been advocated. Analysis of resulting data shows that while the measurement of cardiac markers may not register above a cut-off value that the time differentiated rule-out protocols are valuable indicators of disease. We therefore demonstrate both concept and value of the use of synthetic data that would have taken years to gather and not have been reproducible or repeatable.

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