Duke University School of Medicine, Department of Emergency Medicine, Durham, North Carolina.
King Fahad Armed Forces Hospital, Department of Critical Care Medicine, Jeddah, Kingdom of Saudi Arabia.
West J Emerg Med. 2022 Jan 18;23(2):134-140. doi: 10.5811/westjem.2021.8.52231.
Millions of people present to the emergency department (ED) with chest pain annually. Accurate and timely risk stratification is important to identify potentially life-threatening conditions such as acute coronary syndrome (ACS). An ED-based observation unit can be used to rapidly evaluate patients and reduce ED crowding, but the practice is not universal. We estimated the number of current hospital admissions in the United States (US) eligible for ED-based observation services for patients with symptoms of ACS.
In this cross-sectional analysis we used data from the 2011-2015 National Hospital Ambulatory Medical Care Survey (NHAMCS). Visits were included if patients presented with symptoms of ACS (eg, chest pain, dyspnea), had an electrocardiogram (ECG) and cardiac markers, and were admitted to the hospital. We excluded patients with any of the following: discharge diagnosis of myocardial infarction; cardiac arrest; congestive heart failure, or unstable angina; admission to an intensive care unit; hospital length of stay > 2 days; alteplase administration, central venous catheter insertion, cardiopulmonary resuscitation or endotracheal intubation; or admission after an initial ED observation stay. We extracted data on sociodemographics, hospital characteristics, triage level, disposition from the ED, and year of ED extracted from the NHAMCS. Descriptive statistics were performed using sampling weights to produce national estimates of ED visits. We provide medians with interquartile ranges for continuous variables and percentages with 95% confidence intervals for categorical variables.
During 2011-2015 there were an estimated 675,883,000 ED visits in the US. Of these, 14,353,000 patients with symptoms of ACS and an ED order for an ECG or cardiac markers were admitted to the hospital. We identified 1,883,000 visits that were amenable to ED observation services, where 987,000 (52.4%) were male patients, and 1,318,000 (70%) were White. Further-more, 739,000 (39.2%) and 234,000 (12.4%) were paid for by Medicare and Medicaid, respectively. The majority (45.1%) of observation-amenable hospitalizations were in the Southern US.
Emergency department-based observation unit services for suspected ACS appear to be underused. Over half of potentially observation-amenable admissions were paid for by Medicare and Medicaid. Implementation of ED-based observation units would especially benefit hospitals and patients in the American South.
每年都有数百万人因胸痛到急诊科就诊。准确和及时的风险分层对于识别潜在的危及生命的情况（如急性冠状动脉综合征）非常重要。急诊科观察单元可用于快速评估患者并减少急诊科拥挤，但这种做法并非普遍存在。我们估计，目前美国有多少因急性冠状动脉综合征症状而适合在急诊科接受观察服务的住院患者。
在这项横断面分析中，我们使用了 2011-2015 年国家医院门诊医疗调查（NHAMCS）的数据。如果患者出现急性冠状动脉综合征症状（如胸痛、呼吸困难）、接受心电图（ECG）和心脏标志物检查并住院，我们将纳入研究。我们排除了以下患者：出院诊断为心肌梗死；心脏骤停；充血性心力衰竭或不稳定型心绞痛；入住重症监护病房；住院时间>2 天；使用阿替普酶；插入中心静脉导管；心肺复苏或气管插管；或在初始急诊科观察停留后入院。我们从 NHAMCS 中提取了社会人口统计学、医院特征、分诊级别、急诊科处置以及急诊科年份的数据。使用抽样权重对数据进行描述性统计，以产生急诊科就诊的全国估计数。我们提供了连续变量的中位数和四分位距，以及分类变量的百分比和 95%置信区间。
在 2011-2015 年期间，美国估计有 675883000 次急诊科就诊。其中，14353000 名有急性冠状动脉综合征症状且急诊科开了心电图或心脏标志物检查医嘱的患者住院。我们确定了 1883000 次适合急诊科观察服务的就诊，其中 987000 名（52.4%）为男性患者，1318000 名（70%）为白人。此外，739000 名（39.2%）和 234000 名（12.4%）的就诊分别由医疗保险和医疗补助支付。观察适宜的住院治疗中，有 45.1%发生在美国南部。
疑似急性冠状动脉综合征的急诊科观察单元服务似乎未得到充分利用。超过一半的潜在观察适宜的入院治疗由医疗保险和医疗补助支付。在急诊科实施观察单元将特别使美国南部的医院和患者受益。
