Safety, Efficacy and Cost of a Chest Pain Unit for the Triage of Patients with Acute Chest Pain

pp 285-297

Abstract

Objective

To analyze the results and cost of a Chest Pain Unit (CPU) for the management of patients with chest pain of unclear origin and no ECG changes.

Method

Two hundred and sixteen patients with probable angina or probably not angina and no ischemic ECG changes were studied with a standardized protocol that included clinical observation, serial ECG and serum total CK determination, and a test to evoke ischemia in absence of evidence of ischemia 4-24 hours after consultation. Follow-up was performed at 90 days so as to assess ischemic events. Direct costs of admission to the Chest PainUnit were compared against those of a similar historical control population admitted to our Coronary Care Unit during 1994.

Results

Median stay in the Chest Pain Unit was 18 hours (interquartile range 13-23.5 hours) and mean cost of admission was $ 263, while that of the historic group was 96 hours (49.5-133.75) with a mean cost of $ 769 (p < 0.001). During Chest Pain Unit stay an acute ischemic syndrome was diagnosed in 39patients (18.1%), who presented 8 events (20.5%)in follow-up, compared with 0.6% of events in those 177 patients in whom an acute ischemic syndrome was ruled out (p < 0.001). Diagnostic sensitivity and specificity of the Chest Pain Unit were 97.2% and 97.8% respectively.

Conclusions

In this patients, the Chest Pain Unit simplifies the triage, identifies a group of patients with very low risk of events in follow-up, and reduces cost in comparison with the Coronary Care Unit.