Prospective evaluation of the use of the thrombolysis in myocardial infarction score as a risk stratification tool for chest pain patients admitted to an ED observation unit - 08/12/12
, David Hamilton, BS, Michael Mallin, MD, Kathryn Black, BS, Riann Robbins, BS, Virgil Davis, MD, Troy Madsen, MDAbstract |
Background |
The Thrombolysis in Myocardial Infarction (TIMI) score has shown use in predicting 30-day and 1-year outcomes in emergency department (ED) patients with potential acute coronary syndrome. Few studies have evaluated the TIMI score in risk stratifying patients selected for the ED observation Unit (EDOU). Risk stratification of patients in this group could identify those at risk for significant cardiac events. Our goal was to evaluate TIMI use for risk stratification in this population and compare outcomes among differing scores.
Methods |
A prospective observational study with 30-day telephone follow-up for a 12 month period. Baseline data, outcomes related to EDOU stay, admission, and 30-day outcomes were recorded. TIMI scores were calculated for each patient placed in EDOU. TIMI score was not utilized in the decision to place patients in observation.
Results |
N = 552. Composite outcomes recorded were myocardial infarction, revascularization, or death either during the EDOU stay, inpatient admission, or the 30-day follow-up. Eighteen composite outcomes were recorded: stent (12 patients), coronary artery bypass graft (3 patients), myocardial infarction and stent (2 patients), and myocardial infarction, and coronary artery bypass graft (1 patient). Distribution by TIMI score was: 0 (102 patients), 1 (196), 2 (142), 3 (72), 4 (27), and 5 (5). Risk of composite outcome increased by score: 0 (1%), 1 (2.6%), 2 (2.1%), 3 (6.9%), 4 (11.1%), and 5 (20%). Those with an intermediate risk score (3-5) were also more likely to require admission (15.4% vs 9.8%, P = .048).
Conclusion |
The TIMI risk score may serve as an effective risk stratification tool among chest pain patients selected for EDOU placement. Patients with intermediate-risk by TIMI may be considered for inpatient admission and/or more aggressive evaluation and therapy.
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| ☆ | Funding Sources: University of Utah Medical Group Quality Assessment Grant. |
Vol 31 - N° 1
P. 185-189 - janvier 2013 Retour au numéro
Article précédent
- Gender differences in emergency stroke care and hospital outcome in acute ischemic stroke: a multicenter observational study
- Se Jin Park, Sang Do Shin, Young Sun Ro, Kyoung Jun Song, Juhwan Oh
- Emergency airway management in geriatric and younger patients: analysis of a multicenter prospective observational study
- Taichi Imamura, Calvin A. Brown, Hisashi Ofuchi, Hiroshi Yamagami, Joel Branch, Yusuke Hagiwara, David F.M. Brown, Kohei Hasegawa, on behalf of the Japanese Emergency Medicine Research Alliance Investigators
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