Chest pain observation units run by the Emergency Department are fairly popular – and it’s easy to see why. It eliminates the need to fight a hospitalist for admission, allows for complete coverage of medicolegal liability, captures another set of billing codes for ED revenue, and keeps the cardiologists happy with a steady stream of interpretation and consultation revenue.
Duke University has one of these such chest pain observation units, and this study is a retrospective evaluation of the subgroup of patients aged less than 40 years. Of the 2,231 patients observed for suspected acute coronary syndrome, 362 met eligibility based on age. Of these 362 patients, median age 36, 238 underwent stress testing and the remainder underwent serial enzymes.
From this cohort, there was a single true positive – defined as a patient who underwent a coronary angiogram with an intervention performed.
There were, however, 14 false positives – indeterminate or positive stress tests and one set of positive biomarkers, leading to five negative invasive coronary angiograms.
The authors sum it up quite nicely: “The extremely risk- adverse physician cannot totally exclude the possibility of ACS based on age, but it seems that routine observation for such patients may cause the potential for as much harm as good.”
“Utility of Observation Units For Young Emergency Department Chest Pain Patients”
www.ncbi.nlm.nih.gov/pubmed/22975283