Winchester David E, Stomp Dhane, Shifrin Roger Y, Jois Preeti
Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, 32610-0277, USA.
Crit Pathw Cardiol. 2012 Sep;11(3):123-7. doi: 10.1097/HPC.0b013e31825d28b9.
Chest pain is a common presenting symptom for emergency department (ED) patients; however, a thorough cardiac evaluation can be difficult to complete within the ED setting. Implementation of a stand-alone unit for the evaluation of chest pain may improve care for patients with chest pain. We designed a protocol for identifying patients without an acute coronary syndrome and with low-to-intermediate likelihood of obstructive coronary artery disease (CAD). These patients were monitored in a stand-alone chest pain evaluation center (CPEC) staffed with a small group of providers and tested for CAD, if necessary. In the first 6 weeks of operation, 181 patients were evaluated in the CPEC. The prevalence of CAD risk factors was low. Of the 181 patients, 159 (88%) were discharged home and 22 (12%) required admission to the hospital for further care. We compared the number of chest pain evaluations and admissions for first 6 weeks of operation to the same 6-week period from the 2 previous years. Whereas ED chest pain evaluations increased 66% over the 2-year time frame, the proportion admitted to the hospital decreased from 53% to 42% (P < 0.0001). In conclusion, evidence-based evaluation of chest pain in patients without acute coronary syndrome and with low-to-intermediate likelihood of obstructive CAD can result in the significant majority of patients being discharged from the ED. Creation of a stand-alone CPEC in an academic hospital was associated with a significant reduction in hospital admissions.
胸痛是急诊科患者常见的就诊症状；然而，在急诊科环境中很难完成全面的心脏评估。设立一个独立的胸痛评估单元可能会改善胸痛患者的护理。我们设计了一个方案，用于识别无急性冠状动脉综合征且患阻塞性冠状动脉疾病（CAD）可能性为低到中度的患者。这些患者在由一小批医护人员组成的独立胸痛评估中心（CPEC）接受监测，并在必要时接受CAD检测。在运营的前6周，有181名患者在CPEC接受了评估。CAD危险因素的患病率较低。在这181名患者中，159名（88%）被送回家，22名（12%）需要住院接受进一步治疗。我们将运营前6周的胸痛评估次数和住院人数与前两年相同的6周时间段进行了比较。在两年时间内，急诊科的胸痛评估次数增加了66%，而住院比例从53%降至42%（P<0.0001）。总之，对无急性冠状动脉综合征且患阻塞性CAD可能性为低到中度的患者进行基于证据的胸痛评估，可使绝大多数患者从急诊科出院。在一家学术医院设立独立的CPEC与住院人数显著减少相关。
