Faheem Guirgis, MD, will head to the Windy City later this year to receive a prestigious award that acknowledges his research efforts regarding chest pain and emergency care.
Guirgis, an assistant professor of emergency medicine at the UF College of Medicine – Jacksonville, was selected late last year to receive the Young Investigator Award from the Emergency Medicine Foundation. His selection was the result of a presentation he gave during the 2013 American College of Emergency Physicians’ Research Forum in Seattle.
The presentation was on “Rapid Discharge of Patients Presenting to the Emergency Department with Cocaine Chest Pain: Application of an Abbreviated Cardiac Enzyme Protocol in the Clinical Decision Unit” – a study also facilitated by fellow UF faculty members Steven Godwin, MD, and Kelly Gray-Eurom, MD, among others.
The UF researchers wrote that prior studies have shown that low-risk patients with chest pain related to cocaine abuse can be safely discharged after nine to 12 hours of observation. The goal of this study was to determine the safety of an eight-hour discharge protocol at UF Health Jacksonville.
“Cocaine-associated chest pain is a prevalent problem in urban emergency departments,” Guirgis said. “The reason we decided to come up with this protocol was because we see a large number of these patients annually. We wanted to safely risk-stratify these patients while increasing our efficiency and reducing ED treatment time.”
This retrospective study reviewed patients who were treated from May 2011 through November 2012 using the eight-hour cocaine chest pain protocol. There were 101 patients who represented 111 emergency department admissions. (One of those patients had four visits and seven others had two visits each.) Of that total, 88 percent of the patients had documented cocaine use within 72 hours of admission.
Patients were discharged if they were free of chest pain and if test results of cardiac biomarkers were negative upon admission and at the two-, four- and eight-hour points. Biomarkers are substances produced by the body that signify a certain condition. No patient tested positive for Troponin-T or CK-MB (two relevant cardiac biomarkers) during any point of his or her emergency department stay. A positive testing would have signified a heart attack.
There were 103 discharges and eight inpatient admissions. Of the admitted patients, two had additional stress tests (which were negative) and one was tested again for cardiac biomarkers (which were negative). All eight were discharged.
There were no heart attacks or deaths during a 30-day follow-up period.
“The estimated risk of missing a patient with positive cardiac biomarkers, adverse cardiac event or death within 30 days of using our protocol is almost surely less than 5.1 percent and most likely less than 3.6 percent,” the researchers wrote, given that there were no patients with any of those three primary outcomes.
“Application of our abbreviated cardiac enzyme protocol resulted in the safe and rapid discharge of patients presenting to the ED with cocaine chest pain, as there were no deaths and no adverse cardiac events,” the conclusion said.
Heading to Chicago
Guirgis was selected for the Young Investigator Award from a pool of more than 90 researchers. Each candidate had to have completed his or her residency within the past five years. Guirgis finished his residency in emergency medicine in 2010.
“I was excited to win this award,” said Guirgis, who is also board-certified in emergency medicine. “I think it’s an interesting topic that deserves attention due to the prevalence of this complaint and the variable ways these patients are managed.”
Guirgis will receive the award in October during ACEP’s Scientific Assembly in Chicago.