Validation of a tool to safely triage selected patients with chest pain to unmonitored beds.
OBJECTIVE
To externally validate a chest pain protocol that triages low risk patients with chest pain to an unmonitored bed.


METHODS
Retrospective study of all patients admitted from the emergency department of a tertiary referral public teaching hospital with an admission diagnosis of 'unstable angina' or suspected ischemic chest pain. Data was collected on adverse outcomes and analysed on the basis of intention-to-treat according to the chest pain protocol.


RESULTS
There were no life-threatening arrhythmias, cardiac arrests or deaths within the first 72 h of admission in the group assigned to an unmonitored bed by the chest pain protocol ([0/244]; 0.0%: 95% confidence interval 0.0-1.5%). Four patients had an uncomplicated myocardial infarction, two patients had recurrent ischemic chest pain and one patient developed acute pulmonary oedema ([7/244]; 2.9%: 95% confidence interval 1.2-5.8%).


CONCLUSIONS
This retrospective study externally validated the chest pain protocol. Care in a monitored bed would not have altered outcomes for patients triaged to an unmonitored bed by the chest pain protocol. Compared to current guidelines, application of the chest pain protocol could increase the availability of monitored beds.
Sultana
Ronald V
RV
Department of Emergency Medicine, The Royal Melbourne Hospital, Victoria, Australia. rons@fmh.com.au
Kerr
Debra
D
Kelly
Anne-Maree
AM
Cameron
Peter
P
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000789:Angina, Unstable / Q000175:diagnosis* / Q000401:mortality; D002637:Chest Pain / Q000175:diagnosis* / Q000401:mortality; D003325:Coronary Care Units; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014218:Triage / Q000379:methods*; D014739:Victoria / Q000453:epidemiology