title: Prospective evaluation of the treatment of intermediate-risk chest pain patients in an emergency department observation unit.
abstract: BACKGROUND
  Emergency department observation units (EDOUs) serve an important role in the evaluation and risk stratification of low-risk chest pain patients.
  
  
  OBJECTIVE
  Our goal was to evaluate our EDOU protocol for intermediate-risk chest pain patients and compare outcomes and inpatient admission rates for low-risk and intermediate-risk patients.
  
  
  METHODS
  Prospective observational study with 30-day telephone follow-up for all chest pain patients admitted to our EDOU from June 1, 2009 to May 31, 2010. Our protocol for intermediate-risk chest pain patients includes patients with a self-reported history of coronary artery disease and negative initial cardiac testing in the emergency department. The EDOU protocol involves telemetry, serial cardiac biomarker testing, and mandatory cardiology consultation.
  
  
  RESULTS
  A total of 552 chest pain patients were evaluated, including 100 (18.1%) intermediate-risk and 452 (81.9%) low-risk patients. Intermediate-risk chest pain patients were significantly more likely to have a myocardial infarction or undergo revascularization (stent or coronary artery bypass graft) (8.0% vs. 2.2%, P = 0.008). Intermediate-risk patients had a higher inpatient admission rate (16.0% vs. 8.8%, P = 0.032). There were no significant unanticipated adverse events at 30-day follow-up in either group.
  
  
  CONCLUSIONS
  In conclusion, intermediate-risk chest pain patients in an EDOU had higher rates of significant cardiac events and inpatient admission. Intermediate-risk patients may be appropriate for EDOU placement, given the acceptable inpatient admission rate and the lack of significant adverse events in the 30-day follow-up period. However, given the higher rate of significant cardiac events, the results of our study emphasize the need for increased vigilance and close cardiology consultation in the intermediate-risk group.
authors.affiliation: Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Holly
authors.forename: David
authors.initials: D
authors.lastname: Hamilton
authors.forename: Joseph
authors.initials: J
authors.lastname: Bledsoe
authors.forename: Kathryn
authors.initials: K
authors.lastname: Black
authors.forename: Riann
authors.initials: R
authors.lastname: Robbins
authors.forename: Virgil
authors.initials: V
authors.lastname: Davis
authors.forename: Erik
authors.initials: E
authors.lastname: Barton
authors.forename: Troy
authors.initials: T
authors.lastname: Madsen
mesh_terms: D002637:Chest Pain / Q000209:etiology / Q000628:therapy; D002985:Clinical Protocols / Q000592:standards*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000458:organization & administration; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data