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Clinical features in the emergency department can identify patients with suspected acute coronary syndromes who are safe for care in unmonitored hospital beds
BACKGROUND: Standard practice for patients requiring hospital admission with suspected acute coronary syndromes (ACS) is admission to a monitored cardiology bed. The Western Hospital Chest Pain Protocol was developed to identify a subset of these patients who could be safely managed in an unmonitored bed. AIM: The objective of this prospective study of chest pain patients classified as 'high' or 'intermediate' risk by the Agency for Health Care Policy and Research/National Health and Medical Research Council guidelines was to further evaluate the safety of this protocol. METHODS: This study was a prospective, observational, cohort study investigating the outcomes of patients admitted to hospital with suspected ACS. The primary outcome of interest was death or life-threatening arrhythmia within 24 h of hospital admission. RESULTS: If the Western Hospital Chest Pain Protocol had been strictly applied, there would have been one death in the group assigned to unmonitored beds (1/750; 0.13%, 95% confidence interval 0.01-0.85%) and no other life-threatening arrhythmias. CONCLUSION: There is a subgroup of patients with suspected ACS who require hospital admission who can, based on clinical and biochemical features in the emergency department, be safely assigned to unmonitored beds.
History
Journal
Internal medicine journalVolume
34Issue
11Pagination
594 - 597Publisher
Wiley-BlackwellLocation
Chichester, Eng.Publisher DOI
ISSN
1444-0903Language
engPublication classification
C1.1 Refereed article in a scholarly journalCopyright notice
[2004, Wiley-Blackwell]Usage metrics
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AdultAgedAged, 80 and overChest PainCohort StudiesCoronary DiseaseElectrocardiographyEmergency Service, HospitalFemaleHospitalizationHospitals, CommunityHumansMaleMiddle AgedProspective StudiesRisk FactorsSafety ManagementSyndromeTelemetryScience & TechnologyLife Sciences & BiomedicineMedicine, General & InternalGeneral & Internal Medicinemonitoringrisk stratificationCHEST-PAINUNSTABLE ANGINAINITIAL ELECTROCARDIOGRAMINTENSIVE-CAREPREDICTIONOUTCOMES
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