Utility of observation units for young emergency department chest pain patients.
Abstract
BACKGROUND: Determining which patients presenting to the Emergency Department (ED)
require further work-up for acute coronary syndrome (ACS) can be difficult. The utility
of routine observation for cardiac testing in low-risk young adult patients has been
questioned. STUDY OBJECTIVES: We investigated the rate of positive findings yielded
by routine cardiac observation unit work-up in patients aged 40 years or younger.
METHODS: This was a retrospective observational cohort study of patients aged 18-40
years who were evaluated for ACS in an ED-based observation unit. Data were collected
by trained abstractors from electronic medical records. RESULTS: A total of 362 patients
met inclusion criteria. Of those, 239 received stress testing, yielding five positive
and nine indeterminate results. One other patient had acute troponin elevation while
under observation. The positive stress test patients and troponin-elevated patient
underwent cardiac angiography. Only one positive stress test patient showed significant
coronary stenosis and received coronary interventions. In follow-up data, one patient
had an adverse cardiac outcome within 1 year of index visit, but no coronary interventions.
Thus, only 3 patients had adverse cardiac events, with only one patient warranting
intervention discovered by observation unit stress testing and a second via serial
cardiac markers. CONCLUSION: Routine observation of symptomatic young adults for ACS
had low yield. Observation identified one patient with acute cardiac marker elevation
and further stress testing identified only one patient with intervenable ACS, despite
a high false-positive rate. This suggests that observation and stress testing should
not be routinely performed in this demographic absent other high-risk features.
Type
Journal articleSubject
Acute Coronary SyndromeAdolescent
Adult
Angioplasty, Balloon, Coronary
Cardiac Catheterization
Chest Pain
Cohort Studies
Coronary Angiography
Coronary Artery Bypass
Coronary Stenosis
Echocardiography, Stress
Emergency Service, Hospital
Female
Follow-Up Studies
Hospital Units
Humans
Magnetic Resonance Imaging, Cine
Male
Myocardial Infarction
Retrospective Studies
Tomography, X-Ray Computed
Troponin
Watchful Waiting
Young Adult
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https://hdl.handle.net/10161/12522Published Version (Please cite this version)
10.1016/j.jemermed.2012.07.048Publication Info
Ely, Sora; Chandra, Abhinav; Mani, Giselle; Drake, Weiying; Freeman, Debbie; & Limkakeng,
Alexander T (2013). Utility of observation units for young emergency department chest pain patients. Journal of Emergency Medicine, 44(2). pp. 306-312. 10.1016/j.jemermed.2012.07.048. Retrieved from https://hdl.handle.net/10161/12522.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Alexander Tan Limkakeng Jr.
Professor of Surgery
My personal research interest is finding new ways to diagnose acute coronary syndrome.
In particular, I am interested in novel biomarkers and precision medicine approaches
to this problem. I also have an interest in sepsis and empirical bioethics. As Vice
Chief of Research for the Duke Division of Emergency Medicine, I also work with researchers
from many fields spanning global health, innovation, clinical trials, basic discovery,
and translational research. The

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