University of Utah, Salt Lake City, Utah, USA.
Am J Emerg Med. 2010 Jan;28(1):19-22. doi: 10.1016/j.ajem.2008.09.021.
Few studies have evaluated emergency department (ED) observation unit chest pain protocols for optimal patient characteristics and admission rates. At our 35 000-visits/y ED, we implemented a chest pain protocol for our observation unit that allowed emergency physicians to admit patients with known coronary artery disease (CAD).
We performed a retrospective chart review of all observation unit patients admitted under the chest pain protocol from April 1, 2006, to May 31, 2007. We compared the outcomes of patients who had a history of CAD with those who did not.
Five hundred thirty-one patients were admitted to the observation unit under the chest pain protocol for the 14-month study period. Of these patients, 125 (23.5%) had a history of CAD. Patients with a history of CAD had a higher inpatient admission rate ( 24% vs 8.6%; P < .001), higher rate of a positive stress test or positive coronary computed tomographic scan (32.3% vs 6.9%; P < .001), a higher rate of cardiac catheterization (12% vs 5.9%; P = .02), and a higher rate of stent placement or coronary artery bypass graft (CABG) (7.2% vs 2.2%; P = .007). In multivariate analysis, patient history of CAD was an independent predictor of hospital admission (P = .005) and stent placement or CABG (P = .030).
Patients with known CAD who were admitted to the ED observation unit failed observation status (ie, required hospitalization) and had higher rates of positive testing than those without CAD.
很少有研究评估急诊科（ED）观察单元胸痛方案的最佳患者特征和入院率。在我们每年接待 35000 名患者的 ED，我们为观察单元实施了胸痛方案，允许急诊医生收治已知冠心病（CAD）的患者。
我们对 2006 年 4 月 1 日至 2007 年 5 月 31 日期间根据胸痛方案收入观察单元的所有患者进行了回顾性病历审查。我们比较了有 CAD 病史和无 CAD 病史患者的结局。
在 14 个月的研究期间，有 531 名患者根据胸痛方案被收入观察单元。这些患者中，有 125 名（23.5%）有 CAD 病史。有 CAD 病史的患者住院率更高（24%比 8.6%；P <.001），阳性应激试验或阳性冠状动脉计算机断层扫描（CT）的比例更高（32.3%比 6.9%；P <.001），接受心脏导管插入术的比例更高（12%比 5.9%；P =.02），接受支架置入术或冠状动脉旁路移植术（CABG）的比例更高（7.2%比 2.2%；P =.007）。多变量分析显示，CAD 病史是住院（P =.005）和支架置入术或 CABG（P =.030）的独立预测因素。
收入 ED 观察单元的已知 CAD 患者观察状态失败（即需要住院），阳性检测率高于无 CAD 患者。
