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

Ely, Sora

Chandra, Abhinav

Mani, Giselle

Drake, Weiying

Freeman, Debbie

Limkakeng, Alexander T

United States

2016-08-01T14:00:46Z

2013-02

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.

http://www.ncbi.nlm.nih.gov/pubmed/22975283

S0736-4679(12)00870-0

0736-4679

https://hdl.handle.net/10161/12522

eng

Journal of Emergency Medicine

10.1016/j.jemermed.2012.07.048

Acute Coronary Syndrome

Adolescent

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

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

Journal article

Limkakeng, Alexander T|0000-0002-9822-5595

http://www.ncbi.nlm.nih.gov/pubmed/22975283

306

312

2

Clinical Science Departments

Duke

School of Medicine

Surgery

Surgery, Emergency Medicine

Published

44