Clinical features in the emergency department can identify patients with suspected acute coronary syndromes who are safe for care in unmonitored hospital beds

Internal Medicine Journal

Volumn 34, Issue 11, 2004, Pages 594-597

  Kelly, Anne Maree ^a,b   Kerr, D ^a  

^a UNIVERSITY OF MELBOURNE   (Australia)

^b WESTERN HOSPITAL   (Australia)

Author keywords

Chest pain; Monitoring; Risk stratification

Indexed keywords

ACUTE HEART INFARCTION; ADULT; AGED; ANGINA PECTORIS; ARTICLE; CLINICAL PRACTICE; COHORT ANALYSIS; CONTROLLED STUDY; DEATH; EMERGENCY HEALTH SERVICE; EMERGENCY WARD; HEALTH CARE POLICY; HEART ARRHYTHMIA; HIGH RISK PATIENT; HOSPITAL ADMISSION; HOSPITAL BED; HOSPITAL CARE; HUMAN; MAJOR CLINICAL STUDY; PATIENT CARE; PATIENT MONITORING; PATIENT SELECTION; PRIORITY JOURNAL; PROSPECTIVE STUDY; RISK ASSESSMENT; SAFETY; THORAX PAIN;

ADULT; AGED; AGED, 80 AND OVER; CHEST PAIN; COHORT STUDIES; CORONARY DISEASE; ELECTROCARDIOGRAPHY; EMERGENCY SERVICE, HOSPITAL; FEMALE; HOSPITALIZATION; HOSPITALS, COMMUNITY; HUMANS; MALE; MIDDLE AGED; PROSPECTIVE STUDIES; RISK FACTORS; SAFETY MANAGEMENT; SYNDROME; TELEMETRY;

EID: 9744262440     PISSN: 14440903     EISSN: None     Source Type: Journal    
DOI: 10.1111/j.1445-5994.2004.00650.x     Document Type: Article

References (23)

1. Braunwald E, Mark DB, Jones RH et al. Unstable angina: Diagnosis and management: Clinical practice guideline number 10, AHCPR publication no. 94-0602. Rockville, MD, USA: Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute, Public Health Service, U.S. Department of Health and Human Services; 1994.
2. National Health and Medical Research Council. Diagnosis and management of unstable angina. Clinical practice guidelines. Canberra: Commonwealth of Australia; 1996.
3. Estrada CA, Rosman HS, Prasad NK et al. Role of telemetry monitoring in the non-intensive care unit. Am J Cardiol 1995; 76: 960-65.
4. Hollander JE, Valentine SM, McCuskey CF, Brogan GX. Are monitored telemetry beds necessary for patients with nontraumatic chest pain and normal or nonspecific electrocardiograms? Am J Cardiol 1997; 79: 1110-11.
5. Edmonds E, Kelly AM. Managing potentially ischaemic chest pain and coronary care beds effectively. Aust Health Rev 1997; 20: 40-48.
6. Kelly AM, Edmonds E, Newman R, Amsing N. Managing unstable angina and coronary care beds effectively. Aust Health Rev 1999; 22: 141-50.
7. Kelly AM, Kerr D. It is safe to manage selected patients with acute coronary syndromes in unmonitored beds. J Emerg Med 2001; 21: 227-33.
8. Schull MJ, Redelmeier DA. Continuous electrocardiographic monitoring and cardiac arrest outcomes in 8932 telemetry ward patients. Acad Emerg Med 2000; 7: 647-52.
9. Hollander JE, Sites FD, Schofer FS. Non-ICU monitored beds: Does telemetry improve outcome of low risk chest pain patients. Acad Emerg Med 2002; 9: 490.
10. Sultana RV, Kerr D, Kelly AM, Cameron P. Vailidation of a tool to safely triage selected patients with chest pain to unmonitored beds. Emergency Med (Fremantle) 2002; 14: 393-9.
11. Brush JE, Acampora D et al. Use of the initial electrocardiogram to predict in-hospital complications of acute myocardial infarction. N Engl J Med 1985; 312: 1137-41.
12. Fesmire FM, Percy RF, Wears RL, MacMath TL. Risk stratification according to the initial electrocardiogram in patients with suspected acute myocardial infarction. Arch Intern Med 1989; 149: 1294-7.
13. Karlson BW, Herlitz J, Wiklund O, Richter A, Hjalmarson A. Early prediction of acute myocardial infarction from clinical history, examination and electrocardiogram in the emergency room. Am J Cardiol 1991; 68: 171-5.
14. McCullough PA, Ayad O, O'Neill WW, Goldstein JA. Costs and outcomes of patients admitted with chest pain and essentially normal electrocardiograms. Clin Cardiol 1998; 21: 22-6.
15. Murphy JJ, Connell PA, Hampton JR. Predictors of risk in patients with unstable angina admitted to a district general hospital. Br Heart J 1992; 67: 395-401.
16. Rizik D, Healy S, Margulis A et al. A new clinical classification for hospital prognosis of unstable angina pectoris. Am J Cardiol 1995; 75: 993-7.
17. Goldman L, Cook F, Johnson PA, Rouan GW, Lee TH. Prediction of the need for intensive care in patients in patients who come to emergency departments with acute chest pain. N Engl J Med 1996; 334: 1498-504.
18. Reilly B, Durairaj L, Husain S et al. Performance and potential impact of a chest pain prediction rule in a large public hospital Am J Med 1999; 106: 285-91.
19. Calvin JE, Klein LW, VandenBerg EJ et al. Validated risk stratification model accurately predicts low risk in patients with unstable angina. J Am Coll Cardiol 2000; 36: 1803-8.
20. Wilkinson L, Ellis CJ, Gordon GD et al. Management of patients with unstable angina in a general cardiology unit. N Z Med J 1998; 111: 288-91.
21. Zalenski RJ, Rydman RJ, McCarren M et al. Feasability of a rapid diagnostic protocol for an emergency department chest pain unit. Ann Emerg Med 1997; 29: 99-108.
22. Farkouh ME, Smars PA, Reeder GS et al. A clinical trial of a chest pain observation unit for patients with unstable angina. N Engl J Med 1998; 339: 1882-8.
23. Katz D, Griffin J, Beshansky J. The use of empirical data in the evaluation of the practice guidelines for unstable angina. JAMA 1996; 276: 1568-74.