validation of a high-risk versus low-risk referral model in suspected acute coronary syndrome

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POSTER PRESENTATION Open Access Validation of a high-risk versus low-risk referral model in suspected Acute Coronary Syndrome Christian Backer Mogensen * , Maja Christiansen, Jess Bjerre Jørgensen, Peter Bisgaard Stæhr From 4th Danish Emergency Medicine Conference Roskilde, Denmark. 25-26 November 2011 Background In future Denmark the majority of acute admissions passes through Emergency and Acute Admission Departments (EAAD). For patients with Acute Coronary Syndrome (ACS) considerable improvements have been achieved through the Cardiac Care Units (CCU). Among patients with acute chest pain only a minority have an ACS. This raises the question if it is possible to separate patients with a high-risk of ACS directly to a CCU, and a low-risk patients to EAAD. The aim of this study was to describe how such a risk stratification would perform. Methods Retrospective cohort study of patients with suspicion of ACS. If the 1) ECG was normal (apart from atrial fibril- lation), no persisting chest pain, no history of IHD, heart failure or an ICD, the patient was considered low- risk and admitted to the EAAD, otherwise to the CCU. Results 495 patients were admitted, 51 % low risk patients to the EAAD and 49 % with high risk to the CCU. 17 % had a verified ACS. Among low riskpatients 10 % and high risk25 % had an ACS (p < 0.0001). In multivari- ate analysis high risk group, male gender and age above 60 years had a higher risk of ACS. Other combinations of risk factors increased the sensitivity at the expense of predictive value and accuracy. Conclusion We believe the model can be useful for future develop- ment of referral strategies in acute hospitals in Denmark. Published: 16 April 2012 doi:10.1186/1757-7241-20-S2-P51 Cite this article as: Mogensen et al.: Validation of a high-risk versus low- risk referral model in suspected Acute Coronary Syndrome. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012 20(Suppl 2): P51. Submit your next manuscript to BioMed Central and take full advantage of: Convenient online submission Thorough peer review No space constraints or color figure charges Immediate publication on acceptance Inclusion in PubMed, CAS, Scopus and Google Scholar Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit * Correspondence: [email protected] Emergency Department, Kolding Sygehus, Denmark Mogensen et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012, 20(Suppl 2):P51 © 2012 Mogensen et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Page 1: Validation of a high-risk versus low-risk referral model in suspected Acute Coronary Syndrome

POSTER PRESENTATION Open Access

Validation of a high-risk versus low-risk referralmodel in suspected Acute Coronary SyndromeChristian Backer Mogensen*, Maja Christiansen, Jess Bjerre Jørgensen, Peter Bisgaard Stæhr

From 4th Danish Emergency Medicine ConferenceRoskilde, Denmark. 25-26 November 2011

BackgroundIn future Denmark the majority of acute admissionspasses through Emergency and Acute AdmissionDepartments (EAAD). For patients with Acute CoronarySyndrome (ACS) considerable improvements have beenachieved through the Cardiac Care Units (CCU).Among patients with acute chest pain only a minorityhave an ACS. This raises the question if it is possible toseparate patients with a high-risk of ACS directly to aCCU, and a low-risk patients to EAAD. The aim of thisstudy was to describe how such a risk stratificationwould perform.

MethodsRetrospective cohort study of patients with suspicion ofACS. If the 1) ECG was normal (apart from atrial fibril-lation), no persisting chest pain, no history of IHD,heart failure or an ICD, the patient was considered low-risk and admitted to the EAAD, otherwise to the CCU.

Results495 patients were admitted, 51 % low risk patients tothe EAAD and 49 % with high risk to the CCU. 17 %had a verified ACS. Among ”low risk” patients 10 % and“high risk” 25 % had an ACS (p < 0.0001). In multivari-ate analysis high risk group, male gender and age above60 years had a higher risk of ACS. Other combinationsof risk factors increased the sensitivity at the expense ofpredictive value and accuracy.

ConclusionWe believe the model can be useful for future develop-ment of referral strategies in acute hospitals inDenmark.

Published: 16 April 2012

doi:10.1186/1757-7241-20-S2-P51Cite this article as: Mogensen et al.: Validation of a high-risk versus low-risk referral model in suspected Acute Coronary Syndrome. ScandinavianJournal of Trauma, Resuscitation and Emergency Medicine 2012 20(Suppl 2):P51.

Submit your next manuscript to BioMed Centraland take full advantage of:

• Convenient online submission

• Thorough peer review

• No space constraints or color figure charges

• Immediate publication on acceptance

• Inclusion in PubMed, CAS, Scopus and Google Scholar

• Research which is freely available for redistribution

Submit your manuscript at www.biomedcentral.com/submit* Correspondence: [email protected]

Emergency Department, Kolding Sygehus, Denmark

Mogensen et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine2012, 20(Suppl 2):P51

© 2012 Mogensen et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.