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Effects of Trauma Cases on the Care of Patients Who Have Chest Pain in an Emergency Department

Boutros, Farid MD; Redelmeier, Donald A. MD, MSc(HSR)

Journal of Trauma and Acute Care Surgery: April 2000 - Volume 48 - Issue 4 - p 649-653
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Background: Trauma victims sometimes take priority over other patients because their injuries require immediate treatment. We examined whether such demands might compromise the care of patients with acute chest pain in an emergency department.

Methods: Case patients were patients with chest pain who arrived immediately after a major trauma victim. Control patients were patients with chest pain who arrived on a preceding day when no trauma patient was in the emergency department.

Results: Case and control patients were similar in mean age (60 vs. 60 years, p = not significant), percentage male (47 vs. 53%, p = not significant) and percentage ultimately diagnosed as cardiac (29 vs. 33%, p = not significant). Case patients spent an average of 81 minutes longer in the emergency department (297 vs. 216 minutes, p = 0.009). Similar delays were observed in the subgroup of patients ultimately diagnosed as cardiac (309 vs. 217 minutes, p = 0.029). Case patients had generally worse scores on the American College of Emergency Physicians Quality Assurance Index (75.6 vs. 84.4, p = 0.027), particularly those ultimately diagnosed as cardiac (60.3 vs. 85.1, p = 0.002). The common failures were failure to administer aspirin, undertreatment of ongoing pain, and failure to provide instructions regarding treatment and need to return.

Conclusion: Trauma victims can decrease the timeliness and quality of care for other patients who have potentially life-threatening conditions in an emergency department.

From the University of Toronto Departments of Medicine (F.B., D.A.R.) and Health Administration (D.A.R.); the University of Toronto Program in Clinical Epidemiology and Health Care Research (D.A.R.); and the Sunnybrook and Women’s College Health Sciences Centre Trauma Program (D.A.R.), Toronto Ontario, Canada.

Address for reprints: Donald A. Redelmeier, MD, MSc(HSR), Sunnybrook and Women’s Hospital, G-151, 2075 Bayview Avenue, Toronto Ontario, Canada M4 N 3M5; email: dar@ices.on.ca.

Submitted for publication June 17, 1999.

Accepted for publication January 4, 2000.

Dr. Redelmeier is supported by a career scientist award from the Ontario Ministry of Health and the de Souza Chair of the University of Toronto. This project was partially funded by a grant from the Physician’s Services Incorporated Foundation of Ontario.

© 2000 Lippincott Williams & Wilkins, Inc.