Editor,—I read with interest Goodacre's review of chest pain observation unit (CPOU) experience in the United States.¹ While the title raises a critical question “Should we establish chest pain observation units in the UK?” the subsequent review is unable to help us answer this question. This is because the alternatives to CPOU are likely to vary greatly in the two countries. In the United Kingdom many patients judged to be at low risk will be discharged from the accident and emergency department compared with the more common “routine” inpatient observation in the United States. Indeed in the three randomised studies identified, CPOU was compared in Farkouh's study with monitored cardiology beds and in the studies of Roberts and of Gomez with …