Show simple item record

Utility of observation units for young emergency department chest pain patients.

dc.contributor.author Ely, Sora
dc.contributor.author Chandra, Abhinav
dc.contributor.author Mani, Giselle
dc.contributor.author Drake, Weiying
dc.contributor.author Freeman, Debbie
dc.contributor.author Limkakeng, Alexander T
dc.coverage.spatial United States
dc.date.accessioned 2016-08-01T14:00:46Z
dc.date.issued 2013-02
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/22975283
dc.identifier S0736-4679(12)00870-0
dc.identifier.issn 0736-4679
dc.identifier.uri https://hdl.handle.net/10161/12522
dc.description.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.
dc.language eng
dc.relation.ispartof Journal of Emergency Medicine
dc.relation.isversionof 10.1016/j.jemermed.2012.07.048
dc.subject Acute Coronary Syndrome
dc.subject Adolescent
dc.subject Adult
dc.subject Angioplasty, Balloon, Coronary
dc.subject Cardiac Catheterization
dc.subject Chest Pain
dc.subject Cohort Studies
dc.subject Coronary Angiography
dc.subject Coronary Artery Bypass
dc.subject Coronary Stenosis
dc.subject Echocardiography, Stress
dc.subject Emergency Service, Hospital
dc.subject Female
dc.subject Follow-Up Studies
dc.subject Hospital Units
dc.subject Humans
dc.subject Magnetic Resonance Imaging, Cine
dc.subject Male
dc.subject Myocardial Infarction
dc.subject Retrospective Studies
dc.subject Tomography, X-Ray Computed
dc.subject Troponin
dc.subject Watchful Waiting
dc.subject Young Adult
dc.title Utility of observation units for young emergency department chest pain patients.
dc.type Journal article
duke.contributor.id Limkakeng, Alexander T|0410606
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/22975283
pubs.begin-page 306
pubs.end-page 312
pubs.issue 2
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group School of Medicine
pubs.organisational-group Surgery
pubs.organisational-group Surgery, Emergency Medicine
pubs.publication-status Published
pubs.volume 44
duke.contributor.orcid Limkakeng, Alexander T|0000-0002-9822-5595


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record