Long-term experience with an accelerated protocol for diagnosis of chest pain.
BACKGROUND
More than 6 million patients present annually with chest pain suggestive of acute coronary syndrome. Rapid and accurate diagnosis is essential for best clinical outcomes, for optimal management of hospital resources, and for minimizing medicolegal exposure.


OBJECTIVE
To evaluate the clinical and cost outcomes of an accelerated protocol for chest pain triage in a community-based hospital of moderate size.


METHODS
One hundred successive patients with chest pain were diagnosed according to the Traditional Chest Pain Protocol, which included testing of serial blood samples for creatine kinase (CK)-MB and total CK. These patients were also subjected to the Accelerated Chest Pain Protocol under evaluation, which included testing at shortened intervals for myoglobin and cardiac troponin I in addition to CK and CK-MB. Diagnostic sensitivity and specificity were compared versus the final assigned diagnosis. The Accelerated Chest Pain Protocol was implemented for routine use. Follow-up evaluations were conducted at 1 month (test group A, N = 180) and 22 months (test group B, N = 180). Costs for diagnosis and treatment of the 2 test groups were compared with those for the control group.


RESULTS
The 2 protocols had equivalent specificity values (99%). The sensitivity of the Accelerated Chest Pain Protocol was higher than that of the Traditional Chest Pain Protocol (95% vs 58%). Cost savings of 29% and a reduction in length of stay of 33% were achieved in test group B versus the control group.


CONCLUSIONS
The Accelerated Chest Pain Protocol improved the accuracy and timeliness of diagnosis of acute coronary syndrome while reducing costs.
Caragher
T E
TE
Department of Pathology and Laboratory Medicine, Elmhurst Memorial Hospital, Elmhurst, IL 60126, USA.
Fernandez
B B
BB
Barr
L A
LA
D000368:Aged; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis* / Q000191:economics; D002985:Clinical Protocols; D003365:Costs and Cost Analysis; D003402:Creatine Kinase / Q000097:blood / Q000191:economics; D052279:Creatine Kinase, MB Form; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007527:Isoenzymes / Q000097:blood / Q000191:economics; D007755:Laboratories, Hospital / Q000191:economics; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010338:Pathology, Clinical / Q000191:economics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014218:Triage
D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form