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Patients with suspected acute coronary syndrome in a university hospital emergency department: an observational study.

Ekelund, Ulf LU ; Nilsson, Hans-Jörgen; Frigyesi, Attila LU and Torffvit, Ole LU (2002) In BMC Emergency Medicine 2(1).
Abstract
Background: Improved diagnostics in suspected acute coronary syndrome (ACS) are considered to be needed. To help clarify the current situation and the improvement potential, judged risk in the emergency department (ED) and outcome were analyzed among patients with suspected ACS at a university hospital. Methods: 157 consecutive patients with symptoms of ACS were included at the ED during 10 days. Risk of ACS was estimated in the ED for each patient based on history, physical examination and ECG by assigning them to one of four risk categories; I (obvious myocardial infarction, MI), II (strong suspicion of ACS), III (vague suspicion of ACS), and IV (no suspicion of ACS). Results: 4, 17, 29 and 50% of the patients were allocated to risk... (More)
Background: Improved diagnostics in suspected acute coronary syndrome (ACS) are considered to be needed. To help clarify the current situation and the improvement potential, judged risk in the emergency department (ED) and outcome were analyzed among patients with suspected ACS at a university hospital. Methods: 157 consecutive patients with symptoms of ACS were included at the ED during 10 days. Risk of ACS was estimated in the ED for each patient based on history, physical examination and ECG by assigning them to one of four risk categories; I (obvious myocardial infarction, MI), II (strong suspicion of ACS), III (vague suspicion of ACS), and IV (no suspicion of ACS). Results: 4, 17, 29 and 50% of the patients were allocated to risk categories I-IV respectively. 74 patients (47%) were hospitalized but only 19 (26%) had ACS as the discharge diagnose. In risk categories I-IV, ACS rates were 100, 37, 12 and 0%, respectively. Of those admitted without ACS, at least 37% could probably, given perfect ED diagnostics, have been immediately discharged. 83 patients were discharged from the ED, and among them there were no hospitalizations for ACS or cardiac mortality at 6 months. Only about three patients per 24 h were considered eligible for a potential ED chest pain unit. Conclusions: Almost 75% of the patients hospitalized with suspected ACS did not have it, and some 40% of these patients could probably, given perfect immediate diagnostics, have been managed as outpatients. The potential for diagnostic improvement in the ED seems large. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute coronary syndrome, chest pain, emergency department, outcome
in
BMC Emergency Medicine
volume
2
issue
1
publisher
BioMed Central
external identifiers
  • scopus:1542323078
ISSN
1471-227X
DOI
10.1186/1471-227X-2-1
language
English
LU publication?
yes
id
9ea8ac55-e3f9-42ed-a029-e7adaa1fc419 (old id 110805)
alternative location
http://www.biomedcentral.com/content/pdf/1471-227X-2-1.pdf
date added to LUP
2007-06-26 09:36:04
date last changed
2017-12-10 04:28:00
@article{9ea8ac55-e3f9-42ed-a029-e7adaa1fc419,
  abstract     = {Background: Improved diagnostics in suspected acute coronary syndrome (ACS) are considered to be needed. To help clarify the current situation and the improvement potential, judged risk in the emergency department (ED) and outcome were analyzed among patients with suspected ACS at a university hospital. Methods: 157 consecutive patients with symptoms of ACS were included at the ED during 10 days. Risk of ACS was estimated in the ED for each patient based on history, physical examination and ECG by assigning them to one of four risk categories; I (obvious myocardial infarction, MI), II (strong suspicion of ACS), III (vague suspicion of ACS), and IV (no suspicion of ACS). Results: 4, 17, 29 and 50% of the patients were allocated to risk categories I-IV respectively. 74 patients (47%) were hospitalized but only 19 (26%) had ACS as the discharge diagnose. In risk categories I-IV, ACS rates were 100, 37, 12 and 0%, respectively. Of those admitted without ACS, at least 37% could probably, given perfect ED diagnostics, have been immediately discharged. 83 patients were discharged from the ED, and among them there were no hospitalizations for ACS or cardiac mortality at 6 months. Only about three patients per 24 h were considered eligible for a potential ED chest pain unit. Conclusions: Almost 75% of the patients hospitalized with suspected ACS did not have it, and some 40% of these patients could probably, given perfect immediate diagnostics, have been managed as outpatients. The potential for diagnostic improvement in the ED seems large.},
  author       = {Ekelund, Ulf and Nilsson, Hans-Jörgen and Frigyesi, Attila and Torffvit, Ole},
  issn         = {1471-227X},
  keyword      = {Acute coronary syndrome,chest pain,emergency department,outcome},
  language     = {eng},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {BMC Emergency Medicine},
  title        = {Patients with suspected acute coronary syndrome in a university hospital emergency department: an observational study.},
  url          = {http://dx.doi.org/10.1186/1471-227X-2-1},
  volume       = {2},
  year         = {2002},
}