Estudio descriptivo en relación a los tiempos de demora en pacientes que consultan por dolor torácico en servicio de urgencia de un hospital universitario / Descriptive study related to the waiting time of the patients consulting for thoracic pain in the urgency service of a university hospital

Introducción: En nuestro país las enfermedades cardiovasculares son la primera causa de muerte, en particular el infarto agudo al miocardio. Recomendaciones nacionales basadas en las normativas de garantías explícitas en salud (GES) vigentes, establecen que el tiempo para el electrocardiograma (ECG) y la primera evaluación de un paciente con sintomatología sugerente de síndrome coronario agudo (SCA) sea menor a 30 minutos desde el ingreso al servicio de urgencia. Objetivos: Estudiar los tiempos desde el ingreso al servicio de urgencia hasta el registro del ECG en pacientes que consultan por dolor torácico (DT). Métodos: Se revisó una cohorte consecutiva de pacientes que consultaron por DT no traumático en el servicio de urgencia durante 30 días. Se incluyeron todos los pacientes a quienes se les solicitó ECG dentro de su evaluación. Se obtuvieron los tiempos en relación a la hora de consulta y hora de registro del ECG, características demográficas, diagnósticos de egreso del servicio de urgencia y diferencias en los tiempos según la hora del día de consulta. Los resultados fueron analizados con ANOVA, t de student, Chi cuadrado, y tests no paramétricos de acuerdo a las características y distribución de las variables. Los tiempos puerta-ECG se expresan en medianas y rangos interquantiles. Resultados: Se estudiaron 164 pacientes con DT, la edad promedio fue 50,7 +/- 17,6 años, 60% sexo masculino. En cuanto a los diagnósticos de egreso del servicio de urgencia, un 20% correspondió a DT coronario (síndrome coronario agudo) y un 80% a DT no coronario (cualquier otra etiología). Se analizaron ambos grupos por separado para todas las variables. La media de la edad fue de 63,7+/9,9 años y de 47,4+/17,6 años respectivamente (p< 0,01). Los tiempos puerta-ECG fueron de 15 min. (RIQ 9-39) y de 31 min. (RIQ 15-34) respectivamente (p< 0,01). En cuanto a los tiempos y a los segmentos horarios de turnos, hubo diferencia significativa siendo menor.

In Chile, cardiovascular diseases are the first cause of death, in particular acute myocardial infarction. National recommendations based on current policies established a maximum door to electrocardiogram (ECG) and first evaluation times in patients with chest pain (CP), to be less than 30 minutes. Objectives: Establish the time elapsed from the door of the emergency department (ED) to the recording of the ECG in patients with CP. Method: We reviewed a consecutive cohort of patients presenting with non-traumatic CP to an academic ED during a 30-day period. All patients with CP that had an ECG performed on the ED evaluation where included. We gathered the information on time from the ED admission to ECG, demographic characteristics, ED’s disposition diagnosis and differences in times according to hours of day. The results were analyzed with ANOVA, T test, Chi-square and non-parametric test according to the type and distribution of the data. Results: A total of 164 patients with CP were included. The mean age was 50,7 +/-17,6 years, 60% were men. The ED disposition diagnosis was: 20% coronary chest pain (ACS) and 80% non-coronary CP (other causes of chest pain). Comparing the patients with coronary CP with non coronary CP, the mean age was 63,7 +/-9,9 years and 47,4 +/-17,6 years respectively (p<0,01). When analyzed according to time of day, the frequency of coronary chest pain was higher during the morning period (7:00 to 15:00 hrs) than the evening (15:00 to 23:00 hrs) or night (23:00 to 7:00 hrs), with 27% of patients diagnosed with ACS in the morning versus 16% in the evening and 17% at night. The median door to ECG time was 15 minutes (IQR 9 to 39) for the ACS group and 31 minutes (IQR 18 to 63) for the non-coronary CP group (p<0,0001). There was a significant difference in door to ECG time during the morning versus evening and night, with a median time of 24 minutes (IQR 15 to 34) for morning, 37 minutes...

Unidad de dolor torácico: primera experiencia en Chile / Chest pain unit: first experience in Chile

Background: In large series, nearly 60 percent of admissions for suspected acute coronary syndrome (ACS) had a non-coronary etiology of the pain. However, short term mortality of non recognized ACS patients, mistakenly discharged from the emergency room is at least twice greater than the expected if they would had been admitted. The concept of a chest pain unit (CPU) is a methodological approach developed to address these issues. Aim: To evaluate the efficacy of a CPU in the emergency room of a general hospital for evaluation of acute chest pain. Material and Methods: Prospective study of patients with chest pain admitted in the CPU. After a clinical, electrocardiographic and laboratory evaluation with cardiac injury serum markers, patients were stratified in three risk groups, based on the likelihood of ACS of the American Heart Association. High probability patients were admitted to the Coronary Unit (CU) for treatment. Moderate probability patients remained in the CPU for further evaluation and low probability patients were discharged with telephonic follow-up. Results: Of 407 patients, 35, 30 and 35 percent were stratified as high, intermediate and low probability ACS, respectively. Among patients admitted with high probability, 73 percent had a confirmed ACS diagnosis. Among intermediate probability patients, 86 percent were discharged after an evaluation in the CPU without adverse events in the follow-up. Conclusion: Structured risk evaluation approach in a CPU improves the management of acute chest pain, identifying high probability patients for fast admission and start of treatment in a CU and allowing safe discharge of low probability ones.