P O Collinson1, S Premachandram, K Hashemi. 1. Department of Chemical Pathology, Mayday University Hospital, Croydon CR7 7YE. poctrop@poctrop.demon.co.uk
Abstract
OBJECTIVE: To assess the incidence of prognostically important myocardial damage in patients with chest pain discharged from the emergency department. DESIGN: Prospective observational study. SETTING: District general hospital emergency department. PARTICIPANTS: 110 patients presenting with chest pain of unknown cause who were subsequently discharged home after cardiac causes of chest pain were ruled out by clinical and electrocardiographic investigation. INTERVENTIONS: Patients were reviewed 12-48 hours after presentation by repeat electrocardiography and measurement of cardiac troponin T. MAIN OUTCOME MEASURES: Incidence of missed myocardial damage. RESULTS: Eight (7%) patients had detectable cardiac troponin T on review and seven had concentrations >/=0.1 microg/l. The repeat electrocardiogram showed no abnormality in any patient. CONCLUSION: 6% of the patients discharged from the emergency department had missed prognostically important myocardial damage. Follow up measurement of cardiac troponin T allows convenient audit of clinical performance in the emergency department.
OBJECTIVE: To assess the incidence of prognostically important myocardial damage in patients with chest pain discharged from the emergency department. DESIGN: Prospective observational study. SETTING: District general hospital emergency department. PARTICIPANTS: 110 patients presenting with chest pain of unknown cause who were subsequently discharged home after cardiac causes of chest pain were ruled out by clinical and electrocardiographic investigation. INTERVENTIONS:Patients were reviewed 12-48 hours after presentation by repeat electrocardiography and measurement of cardiac troponin T. MAIN OUTCOME MEASURES: Incidence of missed myocardial damage. RESULTS: Eight (7%) patients had detectable cardiac troponin T on review and seven had concentrations >/=0.1 microg/l. The repeat electrocardiogram showed no abnormality in any patient. CONCLUSION: 6% of the patients discharged from the emergency department had missed prognostically important myocardial damage. Follow up measurement of cardiac troponin T allows convenient audit of clinical performance in the emergency department.
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