Coronary Artery DiseaseImpact on the Care of the Emergency Department Chest Pain Patient from the Chest Pain Evaluation Registry (CHEPER) Study
Section snippets
Methods
This study examined the performance of chest pain observation units in evaluating chest pain patients for possible acute myocardial infarction or acute cardiac ischemia. Eight EDs participated in this study (New Britain General Hospital, Riverside Hospitals, Duke University Medical Center, Charleton Hospital, Overlook Hospital, Ohio Kaiser Permanente, Cleveland Clinic Foundation, and William Beaumont Hospital). All centers complied with American College of Emergency Physician standards for
Results
Eight institutions joined the study, with each site complying with the study criteria for observation (low probability of disease, negative initial tests). Some sites used additional clinical findings or risk factors as admission criteria in their observation unit (Table 1). Patients with ≥1 of these criteria were observed rather than discharged after the initial evaluation.
A total of 23,407 ED patients with the chief complaint of chest pain were enrolled in the study by the end of July 1996 (
Discussion
This study examined whether patients with acute chest pain could be evaluated more thoroughly, with fewer missed infarcts, at a lower overall cost than the “traditional” approach of either admit or discharge. This study takes place at a time when emergency physicians’ leading source of malpractice suits is failure to diagnose and treat myocardial infarction.26, 27It also takes place at a time when third party health care payers are concerned about the high cost of the inpatient diagnostic
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Variation in Health Care Processes, Quality and Outcomes According to Day and Time of Chest Pain Presentation via Ambulance
2023, Heart Lung and CirculationFeasibility and Reliability of Rapid Diagnosis of Myocardial Infarction
2020, American Journal of the Medical SciencesCitation Excerpt :In addition, decreasing the time and expense of the evaluation may decrease the disincentive to observe patients with apparent lowrisk and might thereby reduce the number of neglected myocardial infarctions. Some studies of chest pain observation units using accelerated diagnostic protocols have demonstrated cost savings and reduction in missed myocardial infarctions,24,25 but these studies have predominantly included only lowrisk patients. The results of this retrospective study of chest pain, performed in patients from all risk categories, strongly suggest that an early diagnosis protocol would merit evaluation in a prospective study and that it is likely to be successful.
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2017, American Journal of Emergency MedicineEarly health technology assessment of future clinical decision rule aided triage of patients presenting with acute chest pain in primary care
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