title: Patients with coronary disease fail observation status at higher rates than patients without coronary disease.
abstract: BACKGROUND
  Few studies have evaluated emergency department (ED) observation unit chest pain protocols for optimal patient characteristics and admission rates. At our 35 000-visits/y ED, we implemented a chest pain protocol for our observation unit that allowed emergency physicians to admit patients with known coronary artery disease (CAD).
  
  
  METHODS
  We performed a retrospective chart review of all observation unit patients admitted under the chest pain protocol from April 1, 2006, to May 31, 2007. We compared the outcomes of patients who had a history of CAD with those who did not.
  
  
  RESULTS
  Five hundred thirty-one patients were admitted to the observation unit under the chest pain protocol for the 14-month study period. Of these patients, 125 (23.5%) had a history of CAD. Patients with a history of CAD had a higher inpatient admission rate ( 24% vs 8.6%; P < .001), higher rate of a positive stress test or positive coronary computed tomographic scan (32.3% vs 6.9%; P < .001), a higher rate of cardiac catheterization (12% vs 5.9%; P = .02), and a higher rate of stent placement or coronary artery bypass graft (CABG) (7.2% vs 2.2%; P = .007). In multivariate analysis, patient history of CAD was an independent predictor of hospital admission (P = .005) and stent placement or CABG (P = .030).
  
  
  CONCLUSIONS
  Patients with known CAD who were admitted to the ED observation unit failed observation status (ie, required hospitalization) and had higher rates of positive testing than those without CAD.
authors.affiliation: University of Utah, Salt Lake City, Utah, USA. troy.madsen@hsc.utah.edu
authors.forename: Troy
authors.initials: T
authors.lastname: Madsen
authors.forename: Philip
authors.initials: P
authors.lastname: Bossart
authors.forename: Joseph
authors.initials: J
authors.lastname: Bledsoe
authors.forename: Kurt
authors.initials: K
authors.lastname: Bernhisel
authors.forename: Melissa
authors.initials: M
authors.lastname: Cheng
authors.forename: Teanu
authors.initials: T
authors.lastname: Mataoa
authors.forename: James
authors.initials: J
authors.lastname: Bartlett
authors.forename: Angela
authors.initials: A
authors.lastname: McKellar
authors.forename: Wyatt
authors.initials: W
authors.lastname: Rivas
authors.forename: Nichole
authors.initials: N
authors.lastname: Quick
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis*; D002637:Chest Pain / Q000209:etiology* / Q000628:therapy*; D002985:Clinical Protocols; D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy*; D004636:Emergency Service, Hospital; D005260:Female; D006757:Hospital Units; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies