Chest pain in the emergency room. Importance of a systematic approach
OBJECTIVE: To evaluate the efficiency of a systematic diagnostic approach in patients with chest pain in the emergency room in relation to the diagnosis of acute coronary syndrome (ACS) and the rate of hospitalization in high-cost units. METHODS: One thousand and three consecutive patients with chest pain were screened according to a pre-established process of diagnostic investigation based on the pre-test probability of ACS determinate by chest pain type and ECG changes. RESULTS: Of the 1003 patients, 224 were immediately discharged home because of no suspicion of ACS (route 5) and 119 were immediately transferred to the coronary care united because of ST elevation or left bundle-branch block (LBBB) (route 1) (74% of these had a final diagnosis of acute myocardial infarction [AMI]). Of the 660 patients that remained in the emergency room under observation, 77 (12%) had AMI without ST segment elevation and 202 (31%) had unstable angina (UA). In route 2 (high probability of ACS) 17% of patients had AMI and 43% had UA, whereas in route 3 (low probability) 2% had AMI and 7 % had UA. The admission ECG has been confirmed as a poor sensitivity test for the diagnosis of AMI ( 49%), with a positive predictive value considered only satisfactory (79%). CONCLUSION: A systematic diagnostic strategy, as used in this study, is essential in managing patients with chest pain in the emergency room in order to obtain high diagnostic accuracy, lower cost, and optimization of the use of coronary care unit beds.
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Sociedade Brasileira de Cardiologia - SBC
2000
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oai:scielo:S0066-782X20000001000032000-09-05Chest pain in the emergency room. Importance of a systematic approachBassan,RobertoScofano,MarceloGamarski,RobertoDohmann,Hans FernandoPimenta,LúciaVolschan,AndréAraujo,MônicaClare,CristinaFabrício,MarceloSanmartin,Carlos HenriqueMohallem,KalilGaspar,SergioMacaciel,Renato acute myocardial infarction chest pain emergency room unstable angina OBJECTIVE: To evaluate the efficiency of a systematic diagnostic approach in patients with chest pain in the emergency room in relation to the diagnosis of acute coronary syndrome (ACS) and the rate of hospitalization in high-cost units. METHODS: One thousand and three consecutive patients with chest pain were screened according to a pre-established process of diagnostic investigation based on the pre-test probability of ACS determinate by chest pain type and ECG changes. RESULTS: Of the 1003 patients, 224 were immediately discharged home because of no suspicion of ACS (route 5) and 119 were immediately transferred to the coronary care united because of ST elevation or left bundle-branch block (LBBB) (route 1) (74% of these had a final diagnosis of acute myocardial infarction [AMI]). Of the 660 patients that remained in the emergency room under observation, 77 (12%) had AMI without ST segment elevation and 202 (31%) had unstable angina (UA). In route 2 (high probability of ACS) 17% of patients had AMI and 43% had UA, whereas in route 3 (low probability) 2% had AMI and 7 % had UA. The admission ECG has been confirmed as a poor sensitivity test for the diagnosis of AMI ( 49%), with a positive predictive value considered only satisfactory (79%). CONCLUSION: A systematic diagnostic strategy, as used in this study, is essential in managing patients with chest pain in the emergency room in order to obtain high diagnostic accuracy, lower cost, and optimization of the use of coronary care unit beds.info:eu-repo/semantics/openAccessSociedade Brasileira de Cardiologia - SBCArquivos Brasileiros de Cardiologia v.74 n.1 20002000-01-01info:eu-repo/semantics/articletext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2000000100003en10.1590/S0066-782X2000000100003 |
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Bassan,Roberto Scofano,Marcelo Gamarski,Roberto Dohmann,Hans Fernando Pimenta,Lúcia Volschan,André Araujo,Mônica Clare,Cristina Fabrício,Marcelo Sanmartin,Carlos Henrique Mohallem,Kalil Gaspar,Sergio Macaciel,Renato |
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Bassan,Roberto Scofano,Marcelo Gamarski,Roberto Dohmann,Hans Fernando Pimenta,Lúcia Volschan,André Araujo,Mônica Clare,Cristina Fabrício,Marcelo Sanmartin,Carlos Henrique Mohallem,Kalil Gaspar,Sergio Macaciel,Renato Chest pain in the emergency room. Importance of a systematic approach |
author_facet |
Bassan,Roberto Scofano,Marcelo Gamarski,Roberto Dohmann,Hans Fernando Pimenta,Lúcia Volschan,André Araujo,Mônica Clare,Cristina Fabrício,Marcelo Sanmartin,Carlos Henrique Mohallem,Kalil Gaspar,Sergio Macaciel,Renato |
author_sort |
Bassan,Roberto |
title |
Chest pain in the emergency room. Importance of a systematic approach |
title_short |
Chest pain in the emergency room. Importance of a systematic approach |
title_full |
Chest pain in the emergency room. Importance of a systematic approach |
title_fullStr |
Chest pain in the emergency room. Importance of a systematic approach |
title_full_unstemmed |
Chest pain in the emergency room. Importance of a systematic approach |
title_sort |
chest pain in the emergency room. importance of a systematic approach |
description |
OBJECTIVE: To evaluate the efficiency of a systematic diagnostic approach in patients with chest pain in the emergency room in relation to the diagnosis of acute coronary syndrome (ACS) and the rate of hospitalization in high-cost units. METHODS: One thousand and three consecutive patients with chest pain were screened according to a pre-established process of diagnostic investigation based on the pre-test probability of ACS determinate by chest pain type and ECG changes. RESULTS: Of the 1003 patients, 224 were immediately discharged home because of no suspicion of ACS (route 5) and 119 were immediately transferred to the coronary care united because of ST elevation or left bundle-branch block (LBBB) (route 1) (74% of these had a final diagnosis of acute myocardial infarction [AMI]). Of the 660 patients that remained in the emergency room under observation, 77 (12%) had AMI without ST segment elevation and 202 (31%) had unstable angina (UA). In route 2 (high probability of ACS) 17% of patients had AMI and 43% had UA, whereas in route 3 (low probability) 2% had AMI and 7 % had UA. The admission ECG has been confirmed as a poor sensitivity test for the diagnosis of AMI ( 49%), with a positive predictive value considered only satisfactory (79%). CONCLUSION: A systematic diagnostic strategy, as used in this study, is essential in managing patients with chest pain in the emergency room in order to obtain high diagnostic accuracy, lower cost, and optimization of the use of coronary care unit beds. |
publisher |
Sociedade Brasileira de Cardiologia - SBC |
publishDate |
2000 |
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http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2000000100003 |
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