Effectiveness and Safety of Chest Pain Assessment to Prevent Emergency Admissions: Escape Cluster Randomised Trial: Goodacre S, Cross E, Lewis C, et al. BMJ 2007;335:659

Abstract

This pre- and post-intervention study attempted to determine the effect of chest pain observation units (CPUs) on the rate of hospital admissions and emergency department (ED) visits for chest pain (CP). Fourteen hospitals underwent paired randomization to either develop a dedicated CPU or continue routine care for patients who presented to the ED with a chief complaint of CP. The CPUs varied from hospital to hospital, but all included a dedicated staff capable of measuring biochemical markers, performing electrocardiograms, and arranging exercise treadmill tests immediately or on the following day. The authors measured the proportion of ED visits that were for a chief complaint of CP, the rates of hospital admission for CP, the number of repeat ED visits within 30 days, and the daily all-cause hospital admissions from the ED for 1 year before and after the intervention. The percentage of ED visits for chest pain increased 16% at hospitals with CPUs and only 3.5% at control hospitals (p = 0.08). There was no change in the proportion of hospital admissions for CP at control or intervention hospitals (adjusted odds ratio for hospitals with CPUs 0.998, 95% confidence interval [CI] 0.940–1.059; p = 0.945). Hospitals that instituted CPUs showed a slight increase in the number of repeat ED visits for CP (adjusted odds ratio 1.10, 95% CI 1.00–1.21; p = 0.036). The presence of a CPU was associated with a small increase of 1.0 (95% CI 0.4–1.5; p = 0.001) patient per day in all-cause admissions through the ED. The authors conclude that the creation of a CPU does not decrease the proportion of hospital admissions for patients who present to the ED with a chief complaint of CP.