Analysis of the Resources Employed in the Management of Chest Pain

pp. 41-54

Abstract

Background
The management of chest pain in the emergency room continues to be a clinical challenge. There are not data available about the evolution of these patients in Argentina .

Methods
Patients with 30 years or more, that went to the emergency room complaining about chest pain, were enrolled in an observational multicenter prospective registry. To assess the diagnosis of acute ischemic syndromes in the emergency room and the criterion for hospital admission, sensitivity, specificity, positive predictive value and predictive error were calculated . Resource utilization and patient management were evaluated according to the type of center. Direct costs were calculated .

Results
1255 (98%) patients, out of 1280, that completed a mean follow-up of 32 ± 6 days were analyzed. In 752 (60%) patients a diagnosis was made in the emergency with a sensitivity of 93.4%, specificity of 86.6%, positive predictive value of 79 .9% and predictive error of 4 .2%. These figures for hospital admission were 87.7%, 88.0%, 69.6% and 4.2% respectively. Patients without a conclusive diagnosis in the emergency room had low risk . The fact with more influence in costs was hospital stay (median: 6 days, 4 days in intensive care unit) . The management was different in terms of admission criteria and resource utilization according with the center type .

Conclusions
The emergency room diagnosis is sensitive and specific, but feasible only in 60% of the cases . 30% of the admitted patients do not have a coronary syndrome and 4.2% are sent home with an ongoing acute ischemic syndrome . In patients without a conclusive initial diagnosis the prevalence of this condition and events rate are low; resources are overused in this population. Centers with prepaid
medicine admit more patients, and the hospital stay is significatively longer in centers that care patients with no coverage.