Condition category
Circulatory System
Date applied
Date assigned
Last edited
Retrospectively registered
Overall trial status
Recruitment status
No longer recruiting

Plain English Summary

Background and study aims
Chest pain is extremely common and can be caused by a wide range of conditions. If the problem is related to the heart, it is very important to reach a quick and accurate diagnosis to avoid future complications. For this reason, many patients who come into emergency departments with chest pain are admitted to hospital for observation, even if they do not need to be. On the other hand, some patients who do have problems which require urgent treatment may be discharged if a diagnosis cannot be reached using standard tests. The concept of the chest pain observation unit has been developed to address these problems. These units offer a more in-depth examination of patients with chest pain in order to determine whether patients need to be admitted or discharged from hospital more accurately. The aim of this study is to evaluate the effectiveness of CPUs in the emergency care and accurate diagnosis of chest pain patients

Who can participate?
Adults who have come into Accident and Emergency (A&E) with chest pain.

What does the study involve?
Hospitals are randomly allocated to one of two groups. For hospitals in the first group, a dedicated chest pain observation unit (CPU) is set up. This unit is staffed by three experienced chest pain nurses who have a background in caring for heart patients or emergency medicine. Patients who attend these hospitals with chest pain go into the CPU (on the same day or the following day if out of hours) and receive in-depth tests on their heart function. Patients who are found to have a heart problem are admitted to hospital for further observation. For hospitals in the second group, patients coming into A&E with chest pain are treated in the department in the usual way (at the discretion of the medical staff in that emergency department).

What are the possible benefits and risks of participating?
Not provided at time of registration.

Where is the study run from?
14 NHS hospitals with an Accident and Emergency (A&E) department (UK)

When is the study starting and how long is it expected to run for?
July 2015 to July 2017

Who is funding the study?
NHS Service Delivery & Organisation National R&D Programme (UK)

Who is the main contact?
Dr Steve Goodacre

Trial website

Contact information



Primary contact

Dr Steve Goodacre


Contact details

Health Services Research
University of Sheffield
Regent Court
30 Regent Street
S1 4DA
United Kingdom
+44 (0)114 222 0842

Additional identifiers

EudraCT number number

Protocol/serial number


Study information

Scientific title

Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care


ESCAPE (Effectiveness and Safety of Chest pain Assessment to Prevent Emergency admissions)

Study hypothesis

To evaluate whether Chest Pain Units (CPUs) provide a system of care for emergency patients with acute chest pain that is effective, acceptable, and cost-effective, compared to routine emergency care.

Ethics approval

Not provided at time of registration.

Study design

Multi-centre randomised controlled trial

Primary study design


Secondary study design

Randomised controlled trial

Trial setting

Not specified

Trial type


Patient information sheet


Acute chest pain


1. Fourteen acute NHS hospitals will be selected and randomised so that seven implement CPU care and seven continue to provide routine care
2. Postal questionnaire survey to random sample of 400 patients attending A&E with chest pain over 2 years
3. Face-to-face interviews carried out with random sample of patients who have attended A&E with acute chest pain

Intervention type



Not Specified

Drug names

Primary outcome measures

Proportion of patients admitted to hospital in 2 years.

Secondary outcome measures

No secondary outcome measures

Overall trial start date


Overall trial end date


Reason abandoned


Participant inclusion criteria

Participants will be eligible if they attend Accident and Emergency (A&E) department with a presenting complaint of chest pain or a similar pre-specified term (such as angina or heart attack).

Participant type


Age group




Target number of participants


Participant exclusion criteria

Routine data will be collected for all patients. Potential participants will not be randomly selected for postal questionnaire survey if they are identified as having died by 30 days after attendance.

Recruitment start date


Recruitment end date



Countries of recruitment

United Kingdom

Trial participating centre

Health Services Research
S1 4DA
United Kingdom

Sponsor information


NHS Service Delivery and Organisation Programme (SDO) (UK)

Sponsor details

London School of Hygiene & Tropical Medicine
99 Gower Street
United Kingdom
+44 (0)20 7612 7958

Sponsor type




Funder type


Funder name

NHS Service Delivery & Organisation National R&D Programme (UK) (ref: SDO/2002/41)

Alternative name(s)

Funding Body Type

Funding Body Subtype


Results and Publications

Publication and dissemination plan

Not provided at time of registration

Intention to publish date

Participant level data

Not provided at time of registration

Results - basic reporting

Publication summary

2004 results in
2004 results in
2007 results in
2010 results in

Publication citations

  1. Results

    Goodacre SW, Quinney D, Revill S, Morris F, Capewell S, Nicholl J, Patient and primary care physician satisfaction with chest pain unit and routine care., Acad Emerg Med, 2004, 11, 8, 827-833.

  2. Results

    Goodacre S, Nicholl J, Dixon S, Cross E, Angelini K, Arnold J, Revill S, Locker T, Capewell SJ, Quinney D, Campbell S, Morris F, Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care., BMJ, 2004, 328, 7434, 254, doi: 10.1136/bmj.37956.664236.EE.

  3. Results

    Goodacre S, Cross E, Lewis C, Nicholl J, Capewell S, , Effectiveness and safety of chest pain assessment to prevent emergency admissions: ESCAPE cluster randomised trial., BMJ, 2007, 335, 7621, 659, doi: 10.1136/bmj.39325.624109.AE.

  4. Results

    Cross E, Goodacre S, , Patient satisfaction with chest pain unit care: findings from the Effectiveness and Safety of Chest Pain Assessment to Prevent Emergency Admissions (ESCAPE) cluster randomised trial., Emerg Med J, 2010, 27, 10, 774-778, doi: 10.1136/emj.2009.086298.

Additional files

Editorial Notes

05/020/2016: Added plain English summary.