Electrocardiographic recording and timeliness of clinician evaluation in the emergency department in patients presenting with chest pain.
Acute chest pain (CP), a leading symptom of persons presenting to emergency departments (EDs), may represent a life-threatening emergency or nonurgent condition requiring routine outpatient follow-up. In either case, rapid provision of an electrocardiogram and clinician evaluation are essential for determining appropriate treatment or discharge from the ED. Data from the National Hospital Ambulatory Medical Care Survey were used to estimate the proportion of hospital ED visits for a chief symptom of CP in adults aged >or=25 years with documentation of both an electrocardiogram and mean and/or median wait time to see a clinician in the ED. In 2004, adults aged >or=25 years made nearly 5.3 million (men 2.5, women 2.8) CP-ED visits. Patients arrived by means of ambulance in only 25% of visits. Overall, a quarter of the patients with CP visits waited <10 minutes to see a physician in 2003 to 2004. Mean wait time was 36 +/- 1.7 (SE) minutes, an increase of 5 minutes from that in 1997 to 1998. In 2003 to 2004, provision of an electrocardiogram was documented for about 80% of all patients with CP-related ED visits and 90% of those with visits for undifferentiated or cardiac CP. The odds of having an electrocardiogram taken in the ED increased (p <or=0.05) for older adults, men, and those triaged as emergency cases (vs unknown or no triage) or who waited <10 minutes to see a physician (vs >or=10-minute wait time). A large proportion of visits were for undifferentiated CP (54%). Cardiac CP accounted for 16% (3% ischemic) and noncardiac CP accounted for 30% of visits. Median wait times for a physician were 12 minutes for those with ischemic CP, 15 minutes for those with other cardiac CP, 18 minutes for those with undifferentiated CP, and 25 minutes for those with noncardiac CP. From 1993 to 2004, ED visits for CP increased for younger (25 to 64 years) adults (1993: 15.6 per 1,000 population, 2.5 million visits vs 2004: 20.9 per 1,000, 4.0 million) and decreased for older adults (>or=65 years) (1993: 9.7 per 1,000; 1.5 million vs 2004: 7.3 per 1,000; 1.3 million). In conclusion, most ED patient visits for undifferentiated and cardiac CP included an electrocardiogram and timely clinician evaluation.
Brown
David W
DW
Center for Disease Control and Prevention, Atlanta, Georgia, USA. dbrown6@cdc.gov
Xie
Jipan
J
Mensah
George A
GA
D000328:Adult; D000367:Age Factors; D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data; D002637:Chest Pain / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D017202:Myocardial Ischemia / Q000175:diagnosis; D010343:Patient Admission / Q000706:statistics & numerical data; D010808:Physical Examination / Q000706:statistics & numerical data; D012737:Sex Factors; D013997:Time Factors; D014218:Triage