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November 26, 1997

Chest Pain Evaluation UnitsAn Idea Whose Time Has Come

Author Affiliations

From the Departments of Emergency Medicine, Ohio State University College of Medicine, Columbus (Dr Hoekstra), and the University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Gibler).

JAMA. 1997;278(20):1701-1702. doi:10.1001/jama.1997.03550200077037

In this issue of The Journal, Roberts et al1 present the results of a randomized controlled clinical trial comparing the cost for evaluation of patients with chest pain in an emergency department—based accelerated diagnostic protocol (ADP) vs traditional hospitalization. This article, despite its limitations, addresses some of the controversies in the expanding literature support for emergency department—based ADPs and chest pain evaluation units (CPEUs) as feasible, safe, and effective alternatives to hospital admission for patients with chest pain. Approximately 15% of emergency departments in the United States have established CPEUs. This percentage has been increasing as managed care programs and diminishing resources dictate the need for cost-effective approaches to the care of patients with chest pain. The development of CPEUs for the evaluation of patients with chest pain makes intuitive sense. Patients with possible acute coronary syndrome (ACS) remain a significant challenge for emergency physicians. The inadvertent release of 2%