title: Acute chest pain fast track at the emergency department: who was misdiagnosed for acute coronary syndrome?
abstract: BACKGROUND
  Acute coronary syndrome (ACS) is a commonly treated disease in the emergency department (ED). Acute chest pain is a common presenting symptom of ACS. Acute chest pain fast track (ACPFT) is a triage to cover patients presenting with chest pain with the aims of early detection and treatment for ACS. This study aimed to assess the quality of the ACPFT with the aim of improving the quality of care for ACS patients.
  
  
  METHODS
  This study was conducted at the ED in Mahidol University, Bangkok, Thailand. The inclusion criterion was patients presenting with acute chest pain at the ED. We retrospectively reviewed the medical records of all eligible patients. The primary outcomes of this study were to determine time from door to electrocardiogram and time from door to treatment (coronary angiogram with percutaneous coronary intervention or thrombolytic therapy in the case of ST elevation myocardial infarction). The outcome was compared between those who were in and not in the ACPFT.
  
  
  RESULTS
  During the study period, there were 616 eligible patients who were divided into ACPFT (n=352 patients; 57.1%) and non-ACPFT (n=264 patients; 42.9%) groups. In the ACPFT group (n=352), 315 patients (89.5%) received an electrocardiogram within 10 minutes. The final diagnosis of ACS was made in 80 patients (22.7%) in the ACPFT group and 13 patients (4.9%) in the non-ACPFT group (P-value <0.01). After adjustment using multivariate logistic regression analysis, only epigastric pain was independently associated with being in the ACPFT group (adjusted odds ratio of 0.11; 95% confidence interval of 0.02, 0.56).
  
  
  CONCLUSIONS
  The ACPFT at the ED facilitated the prompt work-ups and intervention for ACS.
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok.
authors.forename: Thidathit
authors.initials: T
authors.lastname: Prachanukool
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok.
authors.forename: Kasamon
authors.initials: K
authors.lastname: Aramvanitch
authors.affiliation: Department of Medicine, Faculty of Medicine; Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH); Internal Medicine Research Group, Faculty of Medicine, Khon Kean University, Khon Kaen, Thailand.
authors.forename: Kittisak
authors.initials: K
authors.lastname: Sawanyawisuth
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok.
authors.forename: Yuwares
authors.initials: Y
authors.lastname: Sitthichanbuncha
keywords: myocardial infarction; outcomes; triage; unstable angina