title: Outcome at 30 days for low-risk chest pain patients assessed using an accelerated diagnostic pathway in the emergency department.
abstract: OBJECTIVE
  Primary: to determine incidence of 30 day major adverse cardiac events (MACE) in patients discharged from the ED following assessment using an accelerated diagnostic pathway (ADP). Secondary: to determine incidence of 30 day MACE for all ADP patients.
  
  
  METHODS
  Monash Health ED patients thought at low risk for acute myocardial infarction (AMI) or hospital admission are assessed using an ADP, based on arrival and 90 min point-of-care (POC) cardiac troponin I and myoglobin concentration. Other patients are assessed using a traditional pathway of arrival and 6 h central lab cardiac troponin I. Choice of pathway is based on the clinical judgement of the attending ED doctor. To investigate the safety of the ADP component, an observational study of all ADP patients presenting from 6 June 2013 to 30 September 2013 was conducted. After 30 days, occurrence of MACE was determined by examination of hospital records or telephone contact with patients who had not returned.
  
  
  RESULTS
  Of 1547 eligible patients, 1384 (89.5%) were followed up. Of the 1143 discharged patients with follow-up information, 30 day MACE occurred in one (0.09%, 95% CI 0.002-0.5). Of all 1547 patients, 60 patients had a MACE detected: 56 AMI during the initial attendance, four AMI post-discharge (one from ED, three after hospital admission). In total, of the 1328 patients who did not have AMI during the target admission and were followed up, 30 day post-discharge MACE occurred in four patients (0.3%, 95% CI 0.08-0.8).
  
  
  CONCLUSIONS
  The ADP supports safe, early discharge of low-risk chest pain patients from the ED.
authors.affiliation: Monash Emergency Medicine Program, Monash Health, Melbourne, Victoria, Australia.|School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Meek
authors.affiliation: Monash Emergency Medicine Program, Monash Health, Melbourne, Victoria, Australia.|School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.|Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Braitberg
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.|Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
authors.affiliation: Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand.|School of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Martin
authors.initials: M
authors.lastname: Than
authors.affiliation: Monash Emergency Medicine Program, Monash Health, Melbourne, Victoria, Australia.|School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
authors.forename: Andis
authors.identifier: http://orcid.org/0000-0002-0310-3983
authors.initials: A
authors.lastname: Graudins
authors.affiliation: Monash Emergency Medicine Program, Monash Health, Melbourne, Victoria, Australia.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Glynn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis*; D019091:Critical Pathways; D003937:Diagnosis, Differential; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D009211:Myoglobin / Q000097:blood; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014336:Troponin / Q000097:blood; D055986:Vital Signs
chemical_list: D015415:Biomarkers; D009211:Myoglobin; D014336:Troponin
keywords: acute coronary syndrome; chest pain; emergency department; practice guideline; treatment outcome