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Prospective Evaluation of the Treatment of Intermediate-risk Chest Pain Patients in an Emergency Department Observation Unit.
MedLine Citation:
PMID:  22337215     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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.
Authors:
Jessica Holly; David Hamilton; Joseph Bledsoe; Kathryn Black; Riann Robbins; Virgil Davis; Erik Barton; Troy Madsen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical pathways in cardiology     Volume:  11     ISSN:  1535-2811     ISO Abbreviation:  Crit Pathw Cardiol     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101165286     Medline TA:  Crit Pathw Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  10-3     Citation Subset:  IM    
Affiliation:
From the Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
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