Changing practice Clinical gems Critical Care

IMProved Assessment of Chest pain Trial: IMPACT.

Thanks to Drs Katrina Starmer and Rob Bonnin for an update on the IMPACT trial starting in ED.

Chest pain is a leading cause for patients presenting to emergency departments (EDs). After an often lengthy assessment process, fewer than one in seven patients are diagnosed with acute coronary syndromes (ACS). Accelerated strategies have been reported for identifying patients at low risk for major adverse cardiac events and therefore suitable for early discharge.


Most studies about accelerated chest pain assessment have been observational in nature, with low risk patients continuing to receive further investigation in an outpatient setting. The benefit of this approach is unproven, and the most recent Heart Foundation/Cardiac Society of Australia and New Zealand guidelines have defined a very low risk group who do not benefit form additional testing. The evidence for safety of this strategy in ATSI patients is unknown.


The IMProved Assessment of Chest pain Trial (IMPACT) protocol, previously called the “Brisbane Protocol”, is an accelerated strategy assessing ED patients presenting with chest pain. IMPACT aimed to improve the efficiency, whilst maintaining safety, for patients with possible ACS using 0- and 2-h sensitive troponin assay results, with a key focus on reducing objective testing of low risk patients.


Details of the health economic outcomes and preliminary clinical outcomes can be found here:


Since mid-2014, this strategy is used in routine care for patients presenting to the RBWH with suspected cardiac chest pain. In Cairns, we are now piloting this strategy with the support of the ED and Cardiology departments. The master pathways can be found within the Cairns Hospital ED share point icon on the ED desktop computers. If you have any questions please don’t hesitate to contact the Director of Emergency, Director of Cardiology or


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