title: Prospective evaluation of the use of the thrombolysis in myocardial infarction score as a risk stratification tool for chest pain patients admitted to an ED observation unit.
abstract: BACKGROUND
  The Thrombolysis in Myocardial Infarction (TIMI) score has shown use in predicting 30-day and 1-year outcomes in emergency department (ED) patients with potential acute coronary syndrome. Few studies have evaluated the TIMI score in risk stratifying patients selected for the ED observation Unit (EDOU). Risk stratification of patients in this group could identify those at risk for significant cardiac events. Our goal was to evaluate TIMI use for risk stratification in this population and compare outcomes among differing scores.
  
  
  METHODS
  A prospective observational study with 30-day telephone follow-up for a 12 month period. Baseline data, outcomes related to EDOU stay, admission, and 30-day outcomes were recorded. TIMI scores were calculated for each patient placed in EDOU. TIMI score was not utilized in the decision to place patients in observation.
  
  
  RESULTS
  N = 552. Composite outcomes recorded were myocardial infarction, revascularization, or death either during the EDOU stay, inpatient admission, or the 30-day follow-up. Eighteen composite outcomes were recorded: stent (12 patients), coronary artery bypass graft (3 patients), myocardial infarction and stent (2 patients), and myocardial infarction, and coronary artery bypass graft (1 patient). Distribution by TIMI score was: 0 (102 patients), 1 (196), 2 (142), 3 (72), 4 (27), and 5 (5). Risk of composite outcome increased by score: 0 (1%), 1 (2.6%), 2 (2.1%), 3 (6.9%), 4 (11.1%), and 5 (20%). Those with an intermediate risk score (3-5) were also more likely to require admission (15.4% vs 9.8%, P = .048).
  
  
  CONCLUSIONS
  The TIMI risk score may serve as an effective risk stratification tool among chest pain patients selected for EDOU placement. Patients with intermediate-risk by TIMI may be considered for inpatient admission and/or more aggressive evaluation and therapy.
authors.affiliation: University of Utah School of Medicine, Department of Surgery, Division of Emergency Medicine, Salt Lake City, UT 84132, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Holly
authors.forename: Matthew
authors.initials: M
authors.lastname: Fuller
authors.forename: David
authors.initials: D
authors.lastname: Hamilton
authors.forename: Michael
authors.initials: M
authors.lastname: Mallin
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: Troy
authors.initials: T
authors.lastname: Madsen
mesh_terms: D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000175:diagnosis* / Q000628:therapy*; D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers