title: Prospective evaluation of outcomes among geriatric chest pain patients in an ED observation unit.
abstract: OBJECTIVE
  Because of concerns of high admission rates and adverse events in geriatric patients, hospitals may exclude this group from emergency department observation unit (EDOU) chest pain protocols. We sought to evaluate characteristics and outcomes of geriatric chest pain patients treated in an EDOU.
  
  
  METHODS
  We performed a prospective, observational study of chest pain patients admitted to our EDOU over a 36-month period. We recorded baseline demographics and risk factors as well as outcomes related to the EDOU stay. We performed 30-day follow-up using telephone contact and review of the electronic medical record.
  
  
  RESULTS
  Over the 36-month study period, 1276 chest pain patients agreed to participate in the study. Two hundred seventy-six patients (21.6%) were 65 years and older. Geriatric patients in the EDOU were more likely to report a history of coronary artery disease than nongeriatric patients (27.1% vs 11.6%, P<.001). There were no clinically significant adverse events nor deaths among geriatric patients. The proportion of geriatric patients who experienced myocardial infarction, stent, or coronary artery bypass graft during the EDOU stay or follow-up period was 4.7% vs 2.7% for nongeriatric patients (P=.09). Inpatient admission rates were significantly higher for geriatric patients (15.6% vs 9.7%, P=.006). Similarly, geriatric patients had higher rates of cardiac catheterization than did nongeriatric patients (13.4% vs 7.9%, P=.005).
  
  
  CONCLUSIONS
  Geriatric patients with chest pain may represent a higher-risk group for evaluation in the EDOU. In our experience, however, these patients were safely evaluated in the EDOU setting and their inpatient admission rate fell within generally accepted guidelines.
authors.affiliation: University of Utah, Salt Lake City, UT. Electronic address: troy.madsen@hsc.utah.edu.
authors.forename: Troy E
authors.initials: TE
authors.lastname: Madsen
authors.affiliation: University of Utah, Salt Lake City, UT.
authors.forename: Matthew
authors.initials: M
authors.lastname: Fuller
authors.affiliation: University of Utah, Salt Lake City, UT; University of North Carolina, Chapel Hill, NC.
authors.forename: Sydney
authors.initials: S
authors.lastname: Hartsell
authors.affiliation: University of Utah, Salt Lake City, UT.
authors.forename: David
authors.initials: D
authors.lastname: Hamilton
authors.affiliation: University of Utah, Salt Lake City, UT; Intermountain Medical Center, Salt Lake City, UT.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bledsoe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000175:diagnosis* / Q000628:therapy*; D002985:Clinical Protocols; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers