Adult Chest Pain in the Pediatric Emergency Department: Treatment and Timeliness From Door In To Door Out.
OBJECTIVE
The American College of Cardiology Foundation/American Heart Association guidelines for acute coronary syndrome (ACS) recommend immediate aspirin (ASA) administration, an electrocardiogram (ECG) in less than 10 minutes, and a door-in to door-out (DIDO) time less than 30 minutes for interfacility transfer. We sought to determine if compliance is hindered when adults with suspected ACS present to pediatric facilities.


METHODS
Visits to the 2 tertiary care emergency departments of a pediatric healthcare system using an adult chest pain protocol were examined from October 2006 to September 2012. Patients older than 18 years with a diagnosis suggestive of ACS and an initial ECG interpretation were identified. Proportions of patients receiving ASA were calculated as well as median times to ECG and DIDO. Bivariate analysis of ECG and DIDO time and the proportion of the patients receiving ASA was conducted for ECG findings positive and negative for ACS.


RESULTS
One hundred thirteen patients were identified. Aspirin was administered in 69% of eligible cases. Electrocardiogram and DIDO times met recommended intervals in 42% (median, 12 minutes) and 5% (median, 59 minutes) of the patients, respectively. No significant differences between positive (22% of total) and negative (78% of total) ECG findings groups were detected in median DIDO time (57 vs 59 minutes, P = 0.99), time to ECG (14 vs 12 minutes, P = 0.45), or the proportion receiving ASA (84% vs 64%, P = 0.08).


CONCLUSIONS
Despite the use of an emergency department protocol, compliance with the American College of Cardiology Foundation/American Heart Association guidelines for adults with suspected ACS remained challenging at this pediatric center. The ECG findings did not seem to impact ASA administration, ECG time, or DIDO time.
From the *Department of Pediatrics, Emory University School of Medicine; †Sibley Heart Center at Children's Healthcare of Atlanta, Atlanta, GA; ‡Department of Medicine, Wake Forest University, Winston-Salem, NC; §Emergency Services, Children's Healthcare of Atlanta; ∥Pediatric Emergency Medicine Associates; and ¶Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA.
Jeffrey H
JH
Sacks
Peter B
PB
Flueckiger
Philip R
PR
Spandorfer
William T
WT
Mahle
Brian E
BE
Costello
D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000628:therapy; D000328:Adult; D001241:Aspirin / Q000008:administration & dosage; D002637:Chest Pain / Q000175:diagnosis* / Q000628:therapy; D004562:Electrocardiography / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010360:Patient Transfer / Q000706:statistics & numerical data; D013997:Time Factors
D001241:Aspirin