Background: The evaluation and triage of patients with suspected myocardial ischemia in the emergency department is challenging and costly. In Italy there are no prospective data neither about the prevalence, clinical characteristics, and outcome of patients with chest pain in the emergency room, nor about the costs of their triage. Therefore, this study was undertaken to evaluate the diagnostic accuracy and costs of the actual emergency department triage modalities of patients with acute chest pain.
Methods: We analyzed the clinical data from a multicenter, prospective study of all patients with chest pain who presented to the emergency department of three hospitals in North-Eastern Italy from April to October 1999.
Results: Of 12,375 new medical admissions at the three emergency departments during the study period, 495 (prevalence 4%, mean age 62 +/- 16 years, 50% females) were for chest pain. Thirty-seven percent of the patients with chest pain were hospitalized with a suspected acute coronary syndrome, while 63% were directly discharged from the emergency department. The diagnosis of acute coronary syndrome was confirmed in 79% of hospitalized patients. Among the patients discharged directly from the emergency department 68% were immediately sent back home (69 +/- 60 min from admission) and 32% required a brief clinical observation lasting 10 +/- 6 hours and including serial electrocardiographic and myocardial injury marker assessment. The average cost of the emergency department triage was 189 +/- 237 [symbol: see text]/patient. The 1-month follow-up of the patients directly discharged from the emergency department revealed a 2.5% incidence of acute coronary syndromes (3 acute myocardial infarctions), but no deaths.
Conclusions: Data obtained from our multicenter observational study suggest that present triage modalities for patients with chest pain in the emergency department based on patient history, clinical data, electrocardiography, and myocardial injury marker assessment could be improved in terms of accuracy and efficacy. Our data provide the clinical and economical framework for the designation of trials of new accelerated critical pathways for chest pain evaluation in the emergency department.