Identifying patients for early discharge: performance of decision rules among patients with acute chest pain. Academic Article Article uri icon

Overview

MeSH

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Time Factors

MeSH Major

  • Chest Pain
  • Decision Making
  • Emergency Service, Hospital
  • Patient Discharge
  • Severity of Illness Index

abstract

  • The HEART score and North American Chest Pain Rule (NACPR) are decision rules designed to identify acute chest pain patients for early discharge without stress testing or cardiac imaging. This study compares the clinical utility of these decision rules combined with serial troponin determinations. A secondary analysis was conducted of 1005 participants in the Myeloperoxidase In the Diagnosis of Acute coronary syndromes Study (MIDAS). MIDAS is a prospective observational cohort of Emergency Department (ED) patients enrolled from 18 US sites with symptoms suggestive of acute coronary syndrome (ACS). The ability to identify participants for early discharge and the sensitivity for ACS at 30 days were compared among an unstructured assessment, NACPR, and HEART score, each combined with troponin measures at 0 and 3h. ACS, defined as cardiac death, acute myocardial infarction, or unstable angina, occurred in 22% of the cohort. The unstructured assessment identified 13.5% (95% CI 11.5-16%) of participants for early discharge with 98% (95% CI 95-99%) sensitivity for ACS. The NACPR identified 4.4% (95% CI 3-6%) for early discharge with 100% (95% CI 98-100%) sensitivity for ACS. The HEART score identified 20% (95% CI 18-23%) for early discharge with 99% (95% CI 97-100%) sensitivity for ACS. The HEART score had a net reclassification improvement of 10% (95% CI 8-12%) versus unstructured assessment and 19% (95% CI 17-21%) versus NACPR. The HEART score with 0 and 3 hour serial troponin measures identifies a substantial number of patients for early discharge while maintaining high sensitivity for ACS. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

publication date

  • September 30, 2013

has subject area

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Chest Pain
  • Cohort Studies
  • Decision Making
  • Emergency Service, Hospital
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Discharge
  • Prospective Studies
  • Severity of Illness Index
  • Time Factors

Research

keywords

  • Clinical Trial
  • Journal Article
  • Multicenter Study
  • Observational Study

Identity

Language

  • eng

PubMed Central ID

  • PMC3565031

Digital Object Identifier (DOI)

  • 10.1016/j.ijcard.2012.10.010

PubMed ID

  • 23117012

Additional Document Info

start page

  • 795

end page

  • 802

volume

  • 168

number

  • 2