Differences in triage thresholds for patients presenting with possible acute coronary syndromes: more than meets the eye.

Journal of investigative medicine : the official publication of the American Federation for Clinical Research

PubMedID: 16472477

Milch CE, Kent DM, Ruthazer R, Pope JH, Aufderheide TP, McNutt RA, Selker HP. Differences in triage thresholds for patients presenting with possible acute coronary syndromes: more than meets the eye. J Investig Med. 2006;54(2):76-85.
BACKGROUND
Many studies have shown differences in cardiac care by racial/ethnic groups without accounting for institutional factors at the location of care.

OBJECTIVE
Exploratory analysis of the effect of hospital funding status (public vs private) on emergency department (ED) triage decision making for patients with symptoms suggestive of acute coronary syndromes (ACSs) and on the likelihood of ED discharge for patients with confirmed ACS.

STUDY DESIGN AND SETTING
Secondary analysis of data from a randomized controlled trial of 10,659 ED patients with possible ACS in five urban academic public and five private hospitals. The main outcome measures were the sensitivity and specificity of hospital admission for the presence of ACS at public and private hospitals and the adjusted odds of a patient with ACS not being hospitalized at public versus private hospitals.

RESULTS
Of 10,659 ED patients, 1,856 had confirmed ACS. For patients with suspected ACS, triage decisions at private hospitals were considerably more sensitive (99 vs 96%; p<.001) but less specific (30 vs 48%; p<.001) than at public hospitals. The difference between hospital types persisted after adjustment for multiple patient-level and hospital-level characteristics.

CONCLUSION
Significant differences in triage for patients with suspected ACS exist between public and private hospital EDs, even after adjustment for multiple patient demographic, clinical, and institutional factors. Further studies are needed to clarify the causes of the differences.