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Predicting re‐presentation following discharge from the emergency department with non‐specific chest pain
Author(s) -
Potezny Tessa M,
Horwood Christopher M,
Hakendorf Paul,
Papendick Cynthia,
Thompson Campbell H
Publication year - 2018
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.12912
Subject(s) - medicine , mace , emergency department , chest pain , logistic regression , presentation (obstetrics) , emergency medicine , population , pediatrics , myocardial infarction , surgery , percutaneous coronary intervention , environmental health , psychiatry
Objective To determine the 30 day major adverse cardiac events (MACE) and re‐presentation rates of non‐specific chest pain (NSCP) patients following four different disposition pathways and to contrast re‐presentation rates of patients with NSCP with those for all other patients presenting to the ED. Methods Cases were derived from the ED database for two large teaching hospitals where patients aged 18 or over were triaged between 2009 and 2016, and their diagnosis on leaving the ED was NSCP. Statewide 30 day rates of MACE and ED re‐presentations were calculated, and multivariable logistic regression analysis identified significant predictors of both. Results A total of 40 183 cases were included; 16 014 discharged directly from the ED, while the remainder were admitted under Cardiology ( n = 7286), General Medicine ( n = 7739) or an ED observation unit ( n = 4086). Compared to discharge directly from the ED, admission was associated with a decreased 30 day re‐presentation rate (OR = 0.857; 95% CI 0.795–0.923; P < 0.001). However, there was no significant difference in adjusted re‐presentation between admitting units. The rates of 30 day MACE were higher in admitted patients, particularly in those admitted to general medicine; however, this difference was accounted for by differing patient characteristics. Conclusion Despite a slightly increased rate of re‐presentation in patients with NSCP sent home from the ED, we conclude that there is minimal advantage in admitting many patients who lack a diagnosis for their chest pain. For a selected patient population, discharge from the ED may become a safe and cost‐effective approach. A prospective randomised study is required.