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Are chest pain observation units essential for rapid and effective emergency care in the UK?1
  1. F Dunn,
  2. D Hughes,
  3. L G R Rocke,
  4. B P McNicholl
  1. Emergency Department, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland;

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    It has been suggested that chest pain observation units are a cost effective solution to the risks inherent in assessing patients at risk of myocardial infarction and its sequelae within emergency departments in the UK. Their function requires that patients are monitored closely for several hours, and they consume significant resources.

    An alternative is the use of a rapid 90 minute rule-out method, incorporating myoglobin along with creatine kinase-MB (CK-MB) and troponin I.2,3 This has a sensitivity and negative predictive value of 100% for myocardial infarction, reduces coronary care unit (CCU) admissions by 40%, and does not require a dedicated observation unit. …

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    • Funding: LGR received part funding for one conference.

    • Competing interests: the test panels for the initial pilot study of 90 patients were provided by the manufacturer Biosite Inc.