Review

Chest pain evaluation units

Gareth Quin

Royal Gwent Hospital, Newport NP9 2UB

Correspondence to:
Correspondence to: Dr Quin, Senior Registrar in Accident and Emergency Medicine (gareth.quin@gwent.wales.nhs.uk)

Accepted December 8, 1999

Introduction

Chest pain is a common cause of accident and emergency (A&E) presentation. In the United States, it accounts for 5–6% of new emergency department attendances.^{1, 2} The principal challenge in these patients is to identify those with an acute coronary syndrome (ACS). Early diagnosis allows effective treatment and inadvertent discharge may have disastrous consequences for patient and doctor: in the United States, between 2–5% of acute myocardial infarctions (AMI) are discharged from the emergency department and 20% of malpractice claims against emergency physicians relate to the management of ACS.³

The problem with the A&E assessment of these patients lies in the limitations of diagnostic tests for acute coronary ischaemia—initial ECG is diagnostic of AMI in only 40–65% of patients and is even less useful in unstable angina.⁴ Despite recent advances, serum markers for myocardial necrosis detect, at best, 66% of AMIs on arrival.⁵ Faced with these diagnostic difficulties and the consequences . . . [Full text of this article]

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This article has been cited by other articles:

• Taylor, C, Forrest-Hay, A, Meek, S (2002). ROMEO: a rapid rule out strategy for low risk chest pain. Does it work in a UK emergency department?. Emerg. Med. J. 19: 395-399 [Abstract] [Full Text]  
• Capewell, S., Quinney, D. (2001). What future for chest pain observation units?. Emerg. Med. J. 18: 3-4 [Full Text]