Troy E Madsen1, Matthew Fuller2, Sydney Hartsell3, David Hamilton2, Joseph Bledsoe4. 1. University of Utah, Salt Lake City, UT. Electronic address: troy.madsen@hsc.utah.edu. 2. University of Utah, Salt Lake City, UT. 3. University of Utah, Salt Lake City, UT; University of North Carolina, Chapel Hill, NC. 4. University of Utah, Salt Lake City, UT; Intermountain Medical Center, Salt Lake City, UT.
Abstract
OBJECTIVE: Because of concerns of high admission rates and adverse events in geriatric patients, hospitals may exclude this group from emergency department observation unit (EDOU) chest pain protocols. We sought to evaluate characteristics and outcomes of geriatric chest pain patients treated in an EDOU. METHODS: We performed a prospective, observational study of chest pain patients admitted to our EDOU over a 36-month period. We recorded baseline demographics and risk factors as well as outcomes related to the EDOU stay. We performed 30-day follow-up using telephone contact and review of the electronic medical record. RESULTS: Over the 36-month study period, 1276 chest pain patients agreed to participate in the study. Two hundred seventy-six patients (21.6%) were 65 years and older. Geriatric patients in the EDOU were more likely to report a history of coronary artery disease than nongeriatric patients (27.1% vs 11.6%, P<.001). There were no clinically significant adverse events nor deaths among geriatric patients. The proportion of geriatric patients who experienced myocardial infarction, stent, or coronary artery bypass graft during the EDOU stay or follow-up period was 4.7% vs 2.7% for nongeriatric patients (P=.09). Inpatient admission rates were significantly higher for geriatric patients (15.6% vs 9.7%, P=.006). Similarly, geriatric patients had higher rates of cardiac catheterization than did nongeriatric patients (13.4% vs 7.9%, P=.005). CONCLUSION: Geriatric patients with chest pain may represent a higher-risk group for evaluation in the EDOU. In our experience, however, these patients were safely evaluated in the EDOU setting and their inpatient admission rate fell within generally accepted guidelines.
OBJECTIVE: Because of concerns of high admission rates and adverse events in geriatric patients, hospitals may exclude this group from emergency department observation unit (EDOU) chest pain protocols. We sought to evaluate characteristics and outcomes of geriatric chest painpatients treated in an EDOU. METHODS: We performed a prospective, observational study of chest painpatients admitted to our EDOU over a 36-month period. We recorded baseline demographics and risk factors as well as outcomes related to the EDOU stay. We performed 30-day follow-up using telephone contact and review of the electronic medical record. RESULTS: Over the 36-month study period, 1276 chest painpatients agreed to participate in the study. Two hundred seventy-six patients (21.6%) were 65 years and older. Geriatric patients in the EDOU were more likely to report a history of coronary artery disease than nongeriatric patients (27.1% vs 11.6%, P<.001). There were no clinically significant adverse events nor deaths among geriatric patients. The proportion of geriatric patients who experienced myocardial infarction, stent, or coronary artery bypass graft during the EDOU stay or follow-up period was 4.7% vs 2.7% for nongeriatric patients (P=.09). Inpatient admission rates were significantly higher for geriatric patients (15.6% vs 9.7%, P=.006). Similarly, geriatric patients had higher rates of cardiac catheterization than did nongeriatric patients (13.4% vs 7.9%, P=.005). CONCLUSION: Geriatric patients with chest pain may represent a higher-risk group for evaluation in the EDOU. In our experience, however, these patients were safely evaluated in the EDOU setting and their inpatient admission rate fell within generally accepted guidelines.
Authors: James Samir Díaz-Betancur; Juan Manuel Martínez; Juan Gabriel Zapata; Isabel Marín-Orozco Journal: Aging Clin Exp Res Date: 2020-10-24 Impact factor: 3.636
Authors: Lauren T Southerland; Anthony J Vargas; Lalitha Nagaraj; Tanya R Gure; Jeffery M Caterino Journal: Acad Emerg Med Date: 2017-11-24 Impact factor: 3.451