title: Emergency department critical care unit for critically ill cardiovascular patients: An observation study.
abstract: BACKGROUND
  We investigated an intensive care model for acute critically cardiovascular emergency patients in the emergency department (ED) as compared with those in the coronary care unit (CCU) after ED visits.
  
  
  METHODS
  We performed a retrospective cohort analysis of patients with acute cardiovascular emergency admitted to the intensive care unit in the ED (EICU) or CCU from January 1, 2010 to March 31, 2011 in an university-affiliated medical center. All clinical characteristics or predictors possibly related to in-hospital mortality were documented, completed, and measured via electronic medical records review. The clinical independent variables with p < 0.1 in univariate analysis were further analyzed by using multiple logistic regression. Survival analysis of the predictors for hospital mortality was assessed by Kaplan-Meier survival curves.
  
  
  RESULTS
  A total of 964 patients were recruited in this study. Of all patients, 328 were enrolled in the EICU group, whereas 636 were enrolled in the CCU group. Multiple regression analysis of both EICU and CCU mortality demonstrated that Acute Physiology and Chronic Health Evaluation II scores were common predictors of mortality in both groups of patients. Based on these scores, Kaplan-Meier survival curves showed no statistically significant differences of cumulative survival rates in both the 7-day and in-hospital survival between both groups.
  
  
  CONCLUSIONS
  Our study demonstrated a feasible and qualified model of intensive care delivery accomplished by collaboration of emergency physicians and cardiologists for acute critically ill cardiovascular emergency patients after initial ED management. Our results suggest that an expanded multicenter study should be conducted to further test and confirm this intriguing model.
authors.affiliation: Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Medicine, Yee-Zen Hospital, Taoyuan, Taiwan, ROC.
authors.forename: Ken-Hui
authors.initials: KH
authors.lastname: Fu
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Yin-Ru
authors.initials: YR
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Ju-Shin
authors.initials: JS
authors.lastname: Fan
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Yen-Chia
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Hsien-Hao
authors.initials: HH
authors.lastname: Huang
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Chorng-Kuang
authors.initials: CK
authors.lastname: How
authors.affiliation: Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: hjyen@vghtpe.gov.tw.
authors.forename: David Hung-Tsang
authors.initials: DH
authors.lastname: Yen
authors.affiliation: Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Shih-Ann
authors.initials: SA
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Emergency Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Mu-Shun
authors.initials: MS
authors.lastname: Huang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000628:therapy*; D016638:Critical Illness / Q000628:therapy*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000628:therapy
keywords: coronary care unit; emergency department; intensive care unit