Use of a clinical decision rule for patients with suspected acute cardiac ischemia can reduce unnecessary admissions to inpatient monitored beds without increasing complications, according to a report in The Journal of the American Medical Association of July 17. Dr. Brendan M. Reilly and colleagues of Cook County Hospital in Chicago performed a prospective impact analysis of a decision rule published in 1996.
The rule stratifies patients’ risk of major complications on the basis of electrocardiographic findings, systolic blood pressure, presence or absence of rales heard above both lung bases, and unstable ischemic heart disease. In their analysis, the researchers included 994 patients seen in the emergency department during 14 consecutive weeks in 1999.
The cohort included all patients in whom acute cardiac ischemia was not ruled out after being evaluated by the ED physician. Thirty-five patients experienced major cardiac complications during the first 72 hours after their evaluation in the ED, of whom 33 were triaged to a coronary care unit or telemetry unit. Thus, safety was estimated at 94%.
This was not significantly different from the 89% safety observed in a pre-intervention group of 207 patients studied during March of 1997.
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