Triage disposition of patients with acute myocardial infarction--ACSIS 2000.
BACKGROUND
In the emergency department the physician is often confronted with the decision of where to hospitalize a patient presenting with chest pain and a possible acute myocardial infarction--in the cardiac care unit or in the internal medicine ward.


OBJECTIVE
To characterize the clinical factors involved in the triage disposition of patients hospitalized with AMI in Israel to either CCUs or IMWs and to determine to what extent the perceived probability of ischemia influenced the disposition decision.


METHODS
During a 2 month nationwide prospective survey in the 26 CCUs and 82 of the 94 IMWs in Israel, we reviewed the charts of 1,648 patients with a discharge diagnosis of AMI. The probability of ischemia at admission was determined retrospectively by the Acute Coronary Ischemia Time-Insensitive Predictive Instrument. Co-morbidity was coded using the Index of Coexistent Diseases.


RESULTS
The ACI-TIPI score for patients admitted to CCUs or to IMWs was 76.2% and 57.7% respectively (P < 0.001). Multivariate analysis showed that young patients with a high probability of ischemia and low co-morbidity or functional impairment were more likely to be hospitalized in CCUs than in IMWs.


CONCLUSIONS
In Israel, the factors that strongly influence the initial triage disposition of AMI patients to CCUs or IMWs are age, perceived probability of ischemia, status of co-morbid conditions and functional impairment.
Arbelle
Jonathan E
JE
Department of Medicine, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Porath
Avi
A
Cohen
Eytan
E
Gilutz
Harel
H
Garty
Moshe
M
D017677:Age Distribution; D000368:Aged; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data*; D004562:Electrocardiography; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D017678:Sex Distribution; D015996:Survival Rate; D014218:Triage / Q000706:statistics & numerical data*