| Prospective Evaluation of the Treatment of Intermediate-risk Chest Pain Patients in an Emergency Department Observation Unit. | |
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MedLine Citation:
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PMID: 22337215 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: : Emergency department observation units (EDOUs) serve an important role in the evaluation and risk stratification of low-risk chest pain patients. OBJECTIVES: : Our goal was to evaluate our EDOU protocol for intermediate-risk chest pain patients and compare outcomes and inpatient admission rates for low-risk and intermediate-risk patients. METHODS: : Prospective observational study with 30-day telephone follow-up for all chest pain patients admitted to our EDOU from June 1, 2009 to May 31, 2010. Our protocol for intermediate-risk chest pain patients includes patients with a self-reported history of coronary artery disease and negative initial cardiac testing in the emergency department. The EDOU protocol involves telemetry, serial cardiac biomarker testing, and mandatory cardiology consultation. RESULTS: : A total of 552 chest pain patients were evaluated, including 100 (18.1%) intermediate-risk and 452 (81.9%) low-risk patients. Intermediate-risk chest pain patients were significantly more likely to have a myocardial infarction or undergo revascularization (stent or coronary artery bypass graft) (8.0% vs. 2.2%, P = 0.008). Intermediate-risk patients had a higher inpatient admission rate (16.0% vs. 8.8%, P = 0.032). There were no significant unanticipated adverse events at 30-day follow-up in either group. CONCLUSIONS: : In conclusion, intermediate-risk chest pain patients in an EDOU had higher rates of significant cardiac events and inpatient admission. Intermediate-risk patients may be appropriate for EDOU placement, given the acceptable inpatient admission rate and the lack of significant adverse events in the 30-day follow-up period. However, given the higher rate of significant cardiac events, the results of our study emphasize the need for increased vigilance and close cardiology consultation in the intermediate-risk group. |
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Authors:
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Jessica Holly; David Hamilton; Joseph Bledsoe; Kathryn Black; Riann Robbins; Virgil Davis; Erik Barton; Troy Madsen |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Critical pathways in cardiology Volume: 11 ISSN: 1535-2811 ISO Abbreviation: Crit Pathw Cardiol Publication Date: 2012 Mar |
Date Detail:
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Created Date: 2012-02-16 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101165286 Medline TA: Crit Pathw Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 10-3 Citation Subset: IM |
Affiliation:
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From the Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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