An Evaluation of a Chest Pain Diagnostic Protocol to Exclude Acute Cardiac Ischemia in the Emergency Department
Archives of Internal MedicinePublished 26 May 1997
Robert J. Zalenski
Citations134
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TL;DR
A chest pain diagnostic protocol achieved high sensitivity and improved specificity over the standard emergency department workup and there were no adverse advents associated with early ExECG.
Abstract
A chest pain diagnostic protocol achieved high sensitivity and improved specificity over the standard emergency department workup. There were no adverse advents associated with early ExECG.
Keywords
Medicine
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The coronary observation unit is safe and adequate for ruling out acute myocardial infarction in a defined subset of patients and strategies such as mandatory but expeditious predischarge stress testing to encourage early but not premature discharge may augment the efficiency of coronary observation units.
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Immediate exercise testing of low-risk patients with chest pain who are at sufficient risk to be designated for hospital admission is effective in further stratifying this group into those who can be safely discharged immediately and those who require hospitalization.
Annals of Emergency MedicineFeasability of a Rapid Diagnostic Protocol for an Emergency Department Chest Pain Unit
76 Citations1997Robert J. Zalenski, Robert J. Rydman +6 more
Although most admitted patients with chest pain were at low probability for AMI, only a minority were eligible for a short-stay protocol that required patients to be free of known coronary artery disease and able to perform an exercise tolerance test.
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Academic Emergency MedicineEmergency‐department Diagnosis of Acute Myocardial Infarction and Ischemia: A Cost Analysis of Two Diagnostic Protocols
70 Citations1994James W. Hoekstra, W B Gibler +7 more
At both centers, hospital charges related to the acute evaluation of chest pain were significantly lower with this emergency-department diagnosis of acute myocardial infarction andmyocardial ischemia using a nine- hour ED evaluation protocol.
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27 Citations1988Dan L. Field, Jerris R. Hedges +3 more
Analysis of follow-up of 318 patients 30 or more years of age with nontraumatic chest pain released from the emergency department of a large urban teaching hospital suggests that specific measures to enhance follow- up must be instituted at urban teaching hospitals if chest pain patients are to be closely followed after ED release.
Annals of Emergency MedicineHow many myocardial infarctions should we rule out?
27 Citations1989Robert L. Wears, Li Sergio +3 more
Computer simulation results imply that the acceptable proportion of false-positive admissions may be as high as 70% to 80%; lower rates could indicate excessively restrictive admitting policies, and Clinicians may be operating closer to the optimal decision point than has previously been asserted.
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27 Citations1992Bahr Rd
The tremendous advances in cardiac patient care are not being delivered to the majority of patients because the patients are entering the system too late and are not taking advantage of prodromal symptoms.
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14 Citations1988Jan Kyst Madsen, Birthe Lykke Thomsen +2 more
It is concluded that patients without confirmed AMI are at risk following discharge and those with an abnormal electrocardiogram at rest and/or during exercise should be followed closely after discharge.
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It is concluded that patients in whom AMI is not confirmed have a high risk of cardiac events following discharge and signs of ischaemic heart disease in the ECG at rest and during exercise can be used to identify high and low risk patients.
