| Abstract: | The study group identified 107 patients who left against advice from the emergency departments of three university and four community hospitals after presenting for evaluation of acute chest pain. In comparison with other emergency department patients with acute chest pain, patients who left against advice had findings that suggested they were at higher risk for myocardial infarction than patients for whom admission was not recommended but at lower risk than patients who consented to be admitted. Specific follow-up plans were made at the time of evaluation for 45 patients (42%). Survival data were obtained at 48–72 hours for 104 patients (97%) and at one month for 101 patients (94%). Fourteen patients (12%) were hospitalized within three days of their original emergency department visits, and three patients had documented acute myocardial infarctions. The only death within one month was that of a patient who died suddenly out-of-hospital later on the day of his emergency department visit. The authors conclude that patients who left against medical advice had presentations and prognoses that were in between those of patients for whom admission was not recommended and those of patients who consented to be admitted. Received from Brigham and Women’s Hospital and Harvard Medical School. Boston, Massachusetts; Yale-New Haven Hospital and Yale University School of Medicine, New Haven Connecticut; and the University of Cincinnati Hospital and University of Cincinnati, Cincinnati, Ohio. Supported in part by a grant (83102-2H) from the John A. Hartford Foundation, New York, New York. Dr. Lee is the recipient of a Public Health Service Clinical Investigator Award (HL01594-01) from the National Heart, Lung, and Blood Institute. Dr. Rouan is a Teaching and Research Scholar of the American College of Physicians. Dr. Goldman was a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine. The Chest Pain Study Group includes Lee Goldman, MD (co-principal investigator). Thomas H. Lee, MD, E. Francis Cook, ScD, Monica C. Weisberg, RN, BS, Karen Daley, BSN, and Barbara C. Rosen, BA,Brigham and Women’s Hospital, Boston, Massachusetts; George Terranova, MD (site director), Carol Stasiulewicz, PA, and David Copen, MD,Danbury Hospital, Danbury, Connecticut; Alan Brandt, MD (site director), and Jay Walshon, MD,Milford Hospital, Milford Connecticut; Louis Gottlieb, MD (site director),St. Mary’s Hospital, Waterbury, Connecticut; Gregory W. Rouan, MD (site director), Robert Toltzis, MD, Jerris R. Hedges, MD, and Beth Goldstein-Wayne, RN,University of Cincinnati Hospital, Cincinnati, Ohio; Michael Kobernick, MD (site of director), and Daniel Jones, BA,William Beaumont Hospital, Royal Oak, Michigan and Donald A. Brand PhD (co-principal investigator). Denise Acampora, MPH, John Mellors, MD, Kathryn Trainor, MS, Rita M. Jakubowski, RN, and Sue Healy, RN,Yale-New Haven Hospital, New Haven, Connecticut. |
