Assessment of Patients with Chest Pain
Authors: Brendan M. Reilly, Arthur T. Evans
Journal: Annals of Internal Medicine (2004)

Letters17 August 2004Assessment of Patients with Chest PainBrendan M. Reilly, MD and Arthur T. Evans, MD, MPHBrendan M. Reilly, MDFrom Cook County Hospital and Rush Medical College, Chicago, IL 60612.Search for more papers by this author and Arthur T. Evans, MD, MPHFrom Cook County Hospital and Rush Medical College, Chicago, IL 60612.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-4-200408170-00023 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We agree with Goldman and Kirtane (1) that perfection is elusive in the triaging of patients with possible acute cardiac ischemia. Three questions may help to reframe this issue usefully, each emphasizing the untapped potential of Goldman's own research.First, what should be the goal of our “search for perfection” in this area? Reducing the rate of missed myocardial infarction (MI) will always be important (2), but the more compelling outcome is the occurrence of life-threatening cardiac events in the few days following triage (3). Although incidence of these events is highest in patients with acute MI, ...References1. Goldman L, Kirtane AJ. Triage of patients with acute chest pain and possible cardiac ischemia: the elusive search for diagnostic perfection. Ann Intern Med. 2003;139:987-95. [PMID: 14678918] LinkGoogle Scholar2. Graff LG, Dallara J, Ross MA, Joseph AJ, Itzcovitz J, Andelman RP, et al . Impact on the care of the emergency department chest pain patient from the chest pain evaluation registry (CHEPER) study. Am J Cardiol. 1997;80:563-8. [PMID: 9294982] CrossrefMedlineGoogle Scholar3. Goldman L, Cook EF, Johnson PA, Brand DA, Rouan GW, Lee TH. Prediction of the need for intensive care in patients who come to the emergency departments with acute chest pain. N Engl J Med. 1996;334:1498-504. [PMID: 8618604] CrossrefMedlineGoogle Scholar4. Reilly BM, Evans AT, Schaider JJ, Das K, Calvin JE, Moran LA, et al . Impact of a clinical decision rule on hospital triage of patients with suspected acute cardiac ischemia in the emergency department. JAMA. 2002;288:342-50. [PMID: 12117399] CrossrefMedlineGoogle Scholar5. Martinez E, Reilly BM, Evans AT, Roberts RR. The observation unit: a new interface between inpatient and outpatient care. Am J Med. 2001;110:274-7. [PMID: 11239845] CrossrefMedlineGoogle Scholar6. Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF. Using risk for advanced proximal colonic neoplasia to tailor endoscopic screening for colorectal cancer. Ann Intern Med. 2003;139:959-65. [PMID: 14678915] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Cook County Hospital and Rush Medical College, Chicago, IL 60612. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoUsing Risk for Advanced Proximal Colonic Neoplasia To Tailor Endoscopic Screening for Colorectal Cancer Thomas F. Imperiale , David R. Wagner , Ching Y. Lin , Gregory N. Larkin , James D. Rogge , and David F. Ransohoff Triage of Patients with Acute Chest Pain and Possible Cardiac Ischemia: The Elusive Search for Diagnostic Perfection Lee Goldman and Ajay J. Kirtane Assessment of Patients with Chest Pain Stephen Workman Assessment of Patients with Chest Pain James R. Johnson Assessment of Patients with Chest Pain Lee Goldman and Ajay J. Kirtane Metrics 17 August 2004Volume 141, Issue 4Page: 325KeywordsColonoscopyCreatineEmergency departmentHeart rateIschemiaMyocardial infarctionSafetySpecificityTriageTroponin ePublished: 17 August 2004 Issue Published: 17 August 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...