- 作者：Jim Christenson ; Grant Innes ; Douglas McKnight ; Christopher R. Thompson ; Hubert Wong ; Eugenia Yu ; Barb Boychuk ; Eric Grafstein ; Frances Rosenberg ; Kenneth Gin ; Aslam Anis ; Joel Singer
- 关键词：patient- and family-centered care ; family-centered care ; family member presence ; cultural sensitivity ; pediatric patient’ ; s medical home
- 刊名：Annals of Emergency Medicine
- 出版年：2006
- 出版时间：January 2006
- 年：2006
- 卷：47
- 期：1
- 页码：1-10
- 全文大小：180 K
Study objective
Current risk stratification tools do not identify very-low-risk patients who can be safely discharged without prolonged emergency department (ED) observation, expensive rule-out protocols, or provocative testing. We seek to develop a clinical prediction rule applicable within 2 hours of ED arrival that would miss fewer than 2 % of acute coronary syndrome patients and allow discharge within 2 to 3 hours for at least 30 % of patients without acute coronary syndrome.Methods
This prospective, cohort study enrolled consenting eligible subjects at least 25 years old at a single site. At 30 days, investigators assigned a diagnosis of acute coronary syndrome or no acute coronary syndrome according to predefined explicit definitions. A recursive partitioning model included risk factors, pain characteristics, physical and ECG findings, and cardiac marker results.
Results
Of 769 patients studied, 77 (10.0 % ) had acute myocardial infarction and 88 (11.4 % ) definite unstable angina. We derived a clinical prediction rule that was 98.8 % sensitive and 32.5 % specific. Patients have very low risk of acute coronary syndrome if they have a normal initial ECG, no previous ischemic chest pain, and age younger than 40 years. In addition, patients at least 40 years old and with a normal ECG result, no previous ischemic chest pain, and low-risk pain characteristics have very low risk if they have an initial creatine kinase-MB (CK-MB) less than 3.0 μg/L or an initial CK-MB greater than or equal to 3.0 μg/L but no ECG or serum-marker increase at 2 hours.
Conclusion
The Vancouver Chest Pain Rule for early discharge defines a group of patients who can be safely discharged after a brief evaluation in the ED. Prospective validation is needed.