Effects of trauma cases on the care of patients who have chest pain in an emergency department

Background: Trauma victims sometimes take priority over other patients beca use their injuries require immediate treatment. We examined whether such de mands might compromise the care of patients with acute chest pain in an eme rgency department. Methods: Case patients were patients with chest pain who arrived immediatel y after a major trauma victim. Control patients were patients with chest pa in who arrived on a preceding day when no trauma patient was in the emergen cy department. Results: Case and control patients were similar in mean age (60 vs. 60 year s, p = not significant), percentage male (47 vs. 53%,p = not significant) a nd percentage ultimately diagnosed as cardiac (29 vs. 33%, p = not signific ant). Case patients spent an average of 81 minutes longer in the emergency department (297 vs. 216 minutes, p = 0.009). Similar delays were observed i n the subgroup of patients ultimately diagnosed as cardiac (309 vs. 217 min utes, 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, undert reatment of ongoing pain, and failure to provide instructions regarding tre atment 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 e mergency department.