Madsen Troy E, Fuller Matthew, Hartsell Sydney, Hamilton David, Bledsoe Joseph
University of Utah, Salt Lake City, UT.
University of Utah, Salt Lake City, UT.
Am J Emerg Med. 2016 Feb;34(2):207-11. doi: 10.1016/j.ajem.2015.10.010. Epub 2015 Oct 23.
Because of concerns of high admission rates and adverse events in geriatric patients, hospitals may exclude this group from emergency department observation unit (EDOU) chest pain protocols. We sought to evaluate characteristics and outcomes of geriatric chest pain patients treated in an EDOU.
We performed a prospective, observational study of chest pain patients admitted to our EDOU over a 36-month period. We recorded baseline demographics and risk factors as well as outcomes related to the EDOU stay. We performed 30-day follow-up using telephone contact and review of the electronic medical record.
Over the 36-month study period, 1276 chest pain patients agreed to participate in the study. Two hundred seventy-six patients (21.6%) were 65 years and older. Geriatric patients in the EDOU were more likely to report a history of coronary artery disease than nongeriatric patients (27.1% vs 11.6%, P<.001). There were no clinically significant adverse events nor deaths among geriatric patients. The proportion of geriatric patients who experienced myocardial infarction, stent, or coronary artery bypass graft during the EDOU stay or follow-up period was 4.7% vs 2.7% for nongeriatric patients (P=.09). Inpatient admission rates were significantly higher for geriatric patients (15.6% vs 9.7%, P=.006). Similarly, geriatric patients had higher rates of cardiac catheterization than did nongeriatric patients (13.4% vs 7.9%, P=.005).
Geriatric patients with chest pain may represent a higher-risk group for evaluation in the EDOU. In our experience, however, these patients were safely evaluated in the EDOU setting and their inpatient admission rate fell within generally accepted guidelines.
由于担心老年患者的高入院率和不良事件，医院可能会将这一群体排除在急诊科观察单元（EDOU）胸痛诊疗方案之外。我们试图评估在EDOU接受治疗的老年胸痛患者的特征和结局。
我们对在36个月期间入住我院EDOU的胸痛患者进行了一项前瞻性观察研究。我们记录了基线人口统计学和危险因素以及与EDOU住院相关的结局。我们通过电话联系和查阅电子病历进行了30天的随访。
在36个月的研究期间，1276名胸痛患者同意参与研究。276名患者（21.6%）年龄在65岁及以上。与非老年患者相比，EDOU中的老年患者更有可能报告有冠状动脉疾病史（27.1%对11.6%，P<0.001）。老年患者中没有临床上显著的不良事件或死亡。在EDOU住院期间或随访期间发生心肌梗死、支架置入或冠状动脉搭桥手术的老年患者比例为4.7%，而非老年患者为2.7%（P=0.09）。老年患者的住院率显著更高（15.6%对9.7%，P=0.006）。同样，老年患者的心脏导管插入术发生率高于非老年患者（13.4%对7.9%，P=0.005）。
胸痛老年患者在EDOU进行评估时可能代表一个更高风险的群体。然而，根据我们的经验，这些患者在EDOU环境中得到了安全评估，其住院率在普遍接受的指南范围内。
