Use of resources for patients with acute chest pain may be improved with clinical strategies that integrate research, Bayesian analysis, and expert opinion.
To 1) develop a critical pathway for management of patients with acute chest pain who are at low risk for complications of ischemic heart disease and 2) assess the potential effects of implementation of the pathway on patient safety and resource use.
Evidence-based consensus and prospective cohort study.
Urban teaching hospital.
Patients at least 30 years of age who were seen in the emergency department for chest pain and who did not have a history of trauma or abnormalities on radiologic study.
Physician-opinion leaders defined criteria for patient inclusion in the pathway and for remaining on the pathway after 6 or 12 hours of observation.
Criteria were defined for appropriateness of direct admission, direct discharge, or 6 hours of observation followed by exercise treadmill testing.
Number of patients admitted to the hospital, number of days that patients were hospitalized, and clinical outcome.
2898 of 4585 patients (63%) were admitted to the hospital ; of the 2898,1152 (40%) were classified as potentially eligible for the pathway and 1068 (93%) had a benign clinical course during the initial observation period.
The 1068 patients had a mean length of stay of 2.8 ± 4.8 days. (...)
Mots-clés Pascal : Angor instable, Méthode chemin critique, Etude cohorte, Infarctus, Myocarde, Facteur risque, Critère décision, Méthode potentiel, Recommandation, Urgence, Homme, Evaluation, Article synthèse, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie, Organisation santé
Mots-clés Pascal anglais : Variant angina, Critical path method, Cohort study, Infarct, Myocardium, Risk factor, Decision criterion, Potential method, Recommendation, Emergency, Human, Evaluation, Review, Cardiovascular disease, Coronary heart disease, Myocardial disease, Public health organization
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0041639
Code Inist : 002B12A03. Création : 17/04/1998.