Nonspecific electrocardiographic abnormalities are associated with increased length of stay and adverse cardiac outcomes in prehospital chest pain

Background: Cocaine-induced chest pain (CICP) is reported in 40% of patients using cocaine and is associated with frequent emergency room visits and hospital admissions. Hypothesis: Coronary computed tomographic angiography (CCTA) has better outcomes than standard-of-care (SOC) for the evaluation of patients with CICP. Method: CICP patients were randomized to CCTA protocol or SOC. The primary outcome of the study was a composite of recurrent emergency room visits and hospital admissions. Secondary outcomes included length of stay, major adverse cardiovascular events and all-cause mortality. Results: The study population consisted of 202 patients with CICP (CCTA=23 and SOC=179). As compared to SOC, the number of emergency room visits in the CCTA group were lower at 30 days (1.04±0.1 vs. 1.24±0.5, p=0.012) and 1 year (2.43±0.9 vs. 2.61±2.1, p=0.008), but not at 3 years (5.04±3.3 vs. 4.87±1, p=0.112) findings that were independent of CCTA results. Mean admission rates for the CCTA group were slightly but not significantly lower than the SOC group at 30 days (0.91±0.1 vs.1.10±0.2 p=0.438) and 1 year (1.52±0.3 vs. 1.82±0.3 p=0.187), but not at 3 years (3.22±0.6 vs. 2.95±0.5, p=0.111). Hospital length of stay was also lower in CCTA patients than in SOC patients (2.61±0.5 vs. 3.34 ± 0.5 p<0.001). After 3 year follow-up, there was 1 major adverse cardiovascular event in the CCTA group compared to 22 in the SOC group (p=0.024). No patient died in the CCTA while 3 patients died from any cause in the SOC group (p=0.776) after 3 years of follow-up. Conclusion: In this prospective randomized trial, CCTA reduced near and intermediate-term but not long-term rates of emergency room visits and hospitalizations. When compared to SOC, the use of CCTA was associated with a reduction of major adverse cardiovascular events. Larger randomized controlled trials to further assess the efficacy of a CCTA-based strategy for CICP appear warranted.

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Does Access to a STAT Cardiology Follow-up Clinic Reduce ED Length of Stay in Patients with Chest Pain?

Academic Emergency Medicine ◽

10.1197/aemj.9.5.373-a ◽

2002 ◽

Vol 9 (5) ◽

pp. 373-a-373

Author(s):

J. Christenson

Keyword(s):

Chest Pain ◽

Length Of Stay

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Coronary CT angiography decreases the length of stay in emergency department versus standard therapy in patients presenting with acute chest pain, but results in increased downstream testing and radiation exposure

Evidence-Based Medicine ◽

10.1136/eb-2012-101011 ◽

2012 ◽

Vol 18 (4) ◽

pp. 146-147 ◽

Cited By ~ 2

Author(s):

James K Min ◽

Reza Arsanjani

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Length Of Stay ◽

Radiation Exposure ◽

Ct Angiography ◽

Standard Therapy ◽

Coronary Ct Angiography ◽

Acute Chest Pain ◽

Coronary Ct

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Diagnostic anticipation to reduce emergency department length of stay: a cohort study in Ferrara University Hospital, Italy

10.21203/rs.3.rs-20219/v1 ◽

2020 ◽

Author(s):

Andrea Strada ◽

Niccolò Bolognesi ◽

Lamberto Manzoli ◽

Giorgia Valpiani ◽

Chiara Morotti ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Abdominal Pain ◽

Chest Pain ◽

Length Of Stay ◽

Diagnostic Algorithm ◽

University Hospital ◽

Blood Tests ◽

Traumatic Bleeding ◽

Ed Crowding

Abstract Background : Emergency Department (ED) crowding reduces staff satisfaction and healthcare quality and safety, which in turn increase costs. Despite a number of proposed solutions, ED length of stay (LOS) - a main cause of overcrowding - remains a major issue worldwide. This cohort study was aimed at evaluating the effectiveness on ED LOS of a procedure called “diagnostic anticipation”, which consisted in anticipating the ordering of blood tests by nurses, at triage, following a diagnostic algorithm approved by physicians. Methods : In the second half of 2019, the ED of the University Hospital of Ferrara, Italy, adopted the diagnostic anticipation protocol on alternate weeks for all patients with chest pain, abdominal pain, and non-traumatic bleeding. Using ED electronic data, LOS independent predictors were evaluated through multiple regression. Results : During the weeks when diagnostic anticipation was adopted, as compared to control weeks, the mean LOS was shorter by 18.2 minutes for chest pain, but longer by 15.7 minutes for abdominal pain, and 33.3 for non-traumatic bleeding. At multivariate analysis, adjusting for age, gender, triage priority and ED crowding, the difference in visit time was significant for chest pain only (p<0.001). Conclusions : The effectiveness of the anticipation of blood testing by nurses varied by patients' condition, being significant for chest pain only. Further research is needed before the implementation, estimating the potential proportion of inappropriate blood tests and ED crowding status

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Select point-of-care testing of patients admitted for chest pain in an emergency department of a secondary hospital: does it decrease the length of stay?

Research ◽

10.13070/rs.en.1.1132 ◽

2014 ◽

Vol 1 ◽

Cited By ~ 1

Author(s):

Cyrielle Alves ◽

Philippe Dussoix ◽

Omar Kherad

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Length Of Stay ◽

Point Of Care ◽

Point Of Care Testing ◽

Secondary Hospital

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Low-Risk Patients With Chest Pain in the Emergency Department: Negative 64-MDCT Coronary Angiography May Reduce Length of Stay and Hospital Charges

American Journal of Roentgenology ◽

10.2214/ajr.08.2021 ◽

2009 ◽

Vol 193 (1) ◽

pp. 150-154 ◽

Cited By ~ 24

Author(s):

Janet M. May ◽

William P. Shuman ◽

Jared N. Strote ◽

Kelley R. Branch ◽

Lee M. Mitsumori ◽

...

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Coronary Angiography ◽

Length Of Stay ◽

Low Risk ◽

Hospital Charges ◽

Risk Patients ◽

Mdct Coronary Angiography

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Elevation of troponin values in differential diagnosis of chest pain in view of pulmonary thromboembolism

Vojnosanitetski pregled ◽

10.2298/vsp1210913v ◽

2012 ◽

Vol 69 (10) ◽

pp. 913-916 ◽

Cited By ~ 1

Author(s):

Rada Vucic ◽

Slavko Knezevic ◽

Zorica Lazic ◽

Olivera Andrejic ◽

Dragan Dincic ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Differential Diagnosis ◽

Heart Disease ◽

Chest Pain ◽

Muscle Injury ◽

Clinical Presentation ◽

Pulmonary Thromboembolism ◽

Coronary Syndrome ◽

Electrocardiographic Abnormalities ◽

D Dimer

Introduction. Acute coronary syndrome, as unstable form of ischaemic heart disease, beside clinical presentation and electrocardiographic abnormalities, is characterized by increased value of troponin one of cardiospecific enzimes. Although troponin is a high specific and sensitive indicator of acute coronary syndrome, any heart muscle injury may induce its increasing, so there are some other diseases with the increased troponin value. Case report. We presented a female patient with chest pain, admitted because of suspicioun of acute coronary sindrome. Performed coronarography excluded ischemic heart disease. Considering symtomatology, electrocardiographic abnormalities, increased troponin and D-dimer values, as well as echocardiography finding we considered pulmonary embolism as a differential diagnosis, which was confirmed by pulmoangiography. Conclusion. Isolated increased troponin values are not enough for diagnosis of acute coronary syndrome.

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