Impact of an abbreviated cardiac enzyme protocol to aid rapid discharge of patients with cocaine-associated chest pain in the clinical decision unit

Faheem W. Guirgis, Kelly Gray-Eurom, Teri L. Mayfield, David M. Imbt, Colleen J. Kalynych, Dale Kraemer, Steven A. Godwin

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction: In 2007 there were 64,000 visits to the emergency department (ED) for possible myocardial infarction (MI) related to cocaine use. Prior studies have demonstrated that low- to intermediate-risk patients with cocaine-associated chest pain can be safely discharged after 9-12 hours of observation. The goal of this study was to determine the safety of an 8-hour protocol for ruling out MI in patients who presented with cocaine-associated chest pain. Methods: We conducted a retrospective review of patients treated with an 8-hour cocaine chest pain protocol between May 1, 2011 and November 30, 2012 who were sent to the clinical decision unit (CDU) for observation. The protocol included serial cardiac biomarker testing with Troponin-T, CK-MB (including delta CK-MB), and total CK at 0, 2, 4, and 8 hours after presentation with cardiac monitoring for the observation period. Patients were followed up for adverse cardiac events or death within 30 days of discharge. Results: There were 111 admissions to the CDU for cocaine chest pain during the study period. One patient had a delta CK-MB of 1.6 ng/ml, but had negative Troponin-T at all time points. No patient had a positive Troponin-T or CK-MB at 0, 2, 4 or 8 hours, and there were no MIs or deaths within 30 days of discharge. Most patients were discharged home (103) and there were 8 inpatient admissions from the CDU. Of the admitted patients, 2 had additional stress tests that were negative, 1 had additional cardiac biomarkers that were negative, and all 8 patients were discharged home. The estimated risk of missing MI using our protocol is, with 99% confidence, less than 5.1% and with 95% confidence, less than 3.6% (99% CI, 0-5.1%; 95% CI, 0-3.6%). Conclusion: Application of an abbreviated cardiac enzyme protocol resulted in the safe and rapid discharge of patients presenting to the ED with cocaine-associated chest pain.

Original languageEnglish (US)
Pages (from-to)180-183
Number of pages4
JournalWestern Journal of Emergency Medicine
Volume15
Issue number2
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Patient Discharge
Chest Pain
Cocaine
Enzymes
Troponin T
Myocardial Infarction
Observation
Hospital Emergency Service
Biomarkers
Exercise Test
Inpatients
Safety

Keywords

  • Chest pain
  • Cocaine-associated chest pain
  • Myocardial infarction
  • Toxicology

ASJC Scopus subject areas

  • Emergency Medicine
  • Medicine(all)

Cite this

Impact of an abbreviated cardiac enzyme protocol to aid rapid discharge of patients with cocaine-associated chest pain in the clinical decision unit. / Guirgis, Faheem W.; Gray-Eurom, Kelly; Mayfield, Teri L.; Imbt, David M.; Kalynych, Colleen J.; Kraemer, Dale; Godwin, Steven A.

In: Western Journal of Emergency Medicine, Vol. 15, No. 2, 01.01.2014, p. 180-183.

Research output: Contribution to journalArticle

Guirgis, Faheem W. ; Gray-Eurom, Kelly ; Mayfield, Teri L. ; Imbt, David M. ; Kalynych, Colleen J. ; Kraemer, Dale ; Godwin, Steven A. / Impact of an abbreviated cardiac enzyme protocol to aid rapid discharge of patients with cocaine-associated chest pain in the clinical decision unit. In: Western Journal of Emergency Medicine. 2014 ; Vol. 15, No. 2. pp. 180-183.
@article{4f3df5b213aa403087a72462613cf57d,
title = "Impact of an abbreviated cardiac enzyme protocol to aid rapid discharge of patients with cocaine-associated chest pain in the clinical decision unit",
abstract = "Introduction: In 2007 there were 64,000 visits to the emergency department (ED) for possible myocardial infarction (MI) related to cocaine use. Prior studies have demonstrated that low- to intermediate-risk patients with cocaine-associated chest pain can be safely discharged after 9-12 hours of observation. The goal of this study was to determine the safety of an 8-hour protocol for ruling out MI in patients who presented with cocaine-associated chest pain. Methods: We conducted a retrospective review of patients treated with an 8-hour cocaine chest pain protocol between May 1, 2011 and November 30, 2012 who were sent to the clinical decision unit (CDU) for observation. The protocol included serial cardiac biomarker testing with Troponin-T, CK-MB (including delta CK-MB), and total CK at 0, 2, 4, and 8 hours after presentation with cardiac monitoring for the observation period. Patients were followed up for adverse cardiac events or death within 30 days of discharge. Results: There were 111 admissions to the CDU for cocaine chest pain during the study period. One patient had a delta CK-MB of 1.6 ng/ml, but had negative Troponin-T at all time points. No patient had a positive Troponin-T or CK-MB at 0, 2, 4 or 8 hours, and there were no MIs or deaths within 30 days of discharge. Most patients were discharged home (103) and there were 8 inpatient admissions from the CDU. Of the admitted patients, 2 had additional stress tests that were negative, 1 had additional cardiac biomarkers that were negative, and all 8 patients were discharged home. The estimated risk of missing MI using our protocol is, with 99{\%} confidence, less than 5.1{\%} and with 95{\%} confidence, less than 3.6{\%} (99{\%} CI, 0-5.1{\%}; 95{\%} CI, 0-3.6{\%}). Conclusion: Application of an abbreviated cardiac enzyme protocol resulted in the safe and rapid discharge of patients presenting to the ED with cocaine-associated chest pain.",
keywords = "Chest pain, Cocaine-associated chest pain, Myocardial infarction, Toxicology",
author = "Guirgis, {Faheem W.} and Kelly Gray-Eurom and Mayfield, {Teri L.} and Imbt, {David M.} and Kalynych, {Colleen J.} and Dale Kraemer and Godwin, {Steven A.}",
year = "2014",
month = "1",
day = "1",
doi = "10.5811/westjem.2013.11.19232",
language = "English (US)",
volume = "15",
pages = "180--183",
journal = "Western Journal of Emergency Medicine",
issn = "1936-900X",
publisher = "University of California",
number = "2",

}

TY - JOUR

T1 - Impact of an abbreviated cardiac enzyme protocol to aid rapid discharge of patients with cocaine-associated chest pain in the clinical decision unit

AU - Guirgis, Faheem W.

AU - Gray-Eurom, Kelly

AU - Mayfield, Teri L.

AU - Imbt, David M.

AU - Kalynych, Colleen J.

AU - Kraemer, Dale

AU - Godwin, Steven A.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Introduction: In 2007 there were 64,000 visits to the emergency department (ED) for possible myocardial infarction (MI) related to cocaine use. Prior studies have demonstrated that low- to intermediate-risk patients with cocaine-associated chest pain can be safely discharged after 9-12 hours of observation. The goal of this study was to determine the safety of an 8-hour protocol for ruling out MI in patients who presented with cocaine-associated chest pain. Methods: We conducted a retrospective review of patients treated with an 8-hour cocaine chest pain protocol between May 1, 2011 and November 30, 2012 who were sent to the clinical decision unit (CDU) for observation. The protocol included serial cardiac biomarker testing with Troponin-T, CK-MB (including delta CK-MB), and total CK at 0, 2, 4, and 8 hours after presentation with cardiac monitoring for the observation period. Patients were followed up for adverse cardiac events or death within 30 days of discharge. Results: There were 111 admissions to the CDU for cocaine chest pain during the study period. One patient had a delta CK-MB of 1.6 ng/ml, but had negative Troponin-T at all time points. No patient had a positive Troponin-T or CK-MB at 0, 2, 4 or 8 hours, and there were no MIs or deaths within 30 days of discharge. Most patients were discharged home (103) and there were 8 inpatient admissions from the CDU. Of the admitted patients, 2 had additional stress tests that were negative, 1 had additional cardiac biomarkers that were negative, and all 8 patients were discharged home. The estimated risk of missing MI using our protocol is, with 99% confidence, less than 5.1% and with 95% confidence, less than 3.6% (99% CI, 0-5.1%; 95% CI, 0-3.6%). Conclusion: Application of an abbreviated cardiac enzyme protocol resulted in the safe and rapid discharge of patients presenting to the ED with cocaine-associated chest pain.

AB - Introduction: In 2007 there were 64,000 visits to the emergency department (ED) for possible myocardial infarction (MI) related to cocaine use. Prior studies have demonstrated that low- to intermediate-risk patients with cocaine-associated chest pain can be safely discharged after 9-12 hours of observation. The goal of this study was to determine the safety of an 8-hour protocol for ruling out MI in patients who presented with cocaine-associated chest pain. Methods: We conducted a retrospective review of patients treated with an 8-hour cocaine chest pain protocol between May 1, 2011 and November 30, 2012 who were sent to the clinical decision unit (CDU) for observation. The protocol included serial cardiac biomarker testing with Troponin-T, CK-MB (including delta CK-MB), and total CK at 0, 2, 4, and 8 hours after presentation with cardiac monitoring for the observation period. Patients were followed up for adverse cardiac events or death within 30 days of discharge. Results: There were 111 admissions to the CDU for cocaine chest pain during the study period. One patient had a delta CK-MB of 1.6 ng/ml, but had negative Troponin-T at all time points. No patient had a positive Troponin-T or CK-MB at 0, 2, 4 or 8 hours, and there were no MIs or deaths within 30 days of discharge. Most patients were discharged home (103) and there were 8 inpatient admissions from the CDU. Of the admitted patients, 2 had additional stress tests that were negative, 1 had additional cardiac biomarkers that were negative, and all 8 patients were discharged home. The estimated risk of missing MI using our protocol is, with 99% confidence, less than 5.1% and with 95% confidence, less than 3.6% (99% CI, 0-5.1%; 95% CI, 0-3.6%). Conclusion: Application of an abbreviated cardiac enzyme protocol resulted in the safe and rapid discharge of patients presenting to the ED with cocaine-associated chest pain.

KW - Chest pain

KW - Cocaine-associated chest pain

KW - Myocardial infarction

KW - Toxicology

UR - http://www.scopus.com/inward/record.url?scp=84896979284&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84896979284&partnerID=8YFLogxK

U2 - 10.5811/westjem.2013.11.19232

DO - 10.5811/westjem.2013.11.19232

M3 - Article

C2 - 24672608

AN - SCOPUS:84896979284

VL - 15

SP - 180

EP - 183

JO - Western Journal of Emergency Medicine

JF - Western Journal of Emergency Medicine

SN - 1936-900X

IS - 2

ER -