Key result
Assignment to a chest pain observation service was independently associated with younger age, complaint of chest pain (OR 2.35; 95% CI 1.34-4.12), and absence of prior coronary artery disease.
Why the study?
Are there differences in clinical characteristics between low-risk ED patients assigned to a chest pain observation service versus an inpatient monitored bed?
Cross-Sectional (n=531)
Are there differences in clinical characteristics between low-risk ED patients assigned to a chest pain observation service versus an inpatient monitored bed?
Odds Ratio: 2.35 (95% CI 1.34–4.12)
Low-risk chest pain patients assigned to observation units are significantly younger and have less prior coronary artery disease compared to those admitted to inpatient beds, highlighting baseline differences that must be accounted for in outcome comparisons.
Baseline imbalances in age and prior CAD between observation and inpatient assignments require adjustment in outcome studies; leaves open whether setting affects results.
OBJECTIVE: To compare and contrast the patient characteristics of ED patients at low risk for acute cardiac ischemia who were assigned to a chest pain observation service vs those admitted to a monitored inpatient bed for "rule-out acute myocardial infarction" (R/O MI). METHODS: This was a retrospective, cross-sectional comparison of adult patients considered at relatively low risk for cardiac ischemia and who were evaluated in 1 of 2 settings: a short-term observation service and an inpatient monitored bed. All patients had an ED final diagnosis of "chest pain," "R/O MI," or "unstable angina" during the 7-month study period. Demographic features and presenting clinical features were examined as a function of site of patient evaluation. RESULTS: Of 531 study patients, 265 (50%) were assigned to the observation service. Younger age (OR = 1.75, 95% CI 1.26, 2.44, for each decrement of 20 years), the complaint of "chest pain" (OR = 2.35, 95% CI 1.34, 4.12), and the absence of prior known coronary artery disease (OR = 1.64, 95% CI 1.13, 2.38) were the principal independent factors associated with assignment to a chest pain observation service bed. CONCLUSIONS: Patients evaluated in a chest pain observation service appear to have different clinical characteristics than other individuals admitted to a monitored inpatient bed for "R/O MI." Investigators should address differences in clinical characteristics when making outcome comparisons between these 2 patient groups.
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Dallara et al. (1997) conducted a cross-sectional in ED patients at low risk for acute cardiac ischemia (n=531). Chest pain observation service vs. Admitted to a monitored inpatient bed for 'rule-out acute myocardial infarction' was evaluated on Factors associated with assignment to a chest pain observation service bed (e.g., complaint of chest pain) (OR 2.35, 95% CI 1.34-4.12). Assignment to a chest pain observation service was independently associated with younger age, complaint of chest pain (OR 2.35; 95% CI 1.34-4.12), and absence of prior coronary artery disease.
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