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The ethical dilemma of emergency department patients with low-risk chest pain
  1. Nella W Hendley1,
  2. John Moskop2,
  3. Nicklaus P Ashburn1,
  4. SA Mahler1,
  5. Jason P Stopyra1
  1. 1Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  2. 2Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr Nella W Hendley, Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; chendley{at}


Millions of patients present to US EDs each year with symptoms concerning for acute coronary syndrome (ACS), but fewer than 10% are ultimately diagnosed with ACS. Well-tested and externally validated accelerated diagnostic protocols were developed to aid providers in risk stratifying patients with possible ACS and have become central components of current ED practice guidelines. Nevertheless, the fear of missing ACS continues to be a strong motivator for ED providers to pursue further testing for their patients. An ethical dilemma arises when the provider must balance the risk of ACS if the patient is discharged compared with the potential harms caused by a cardiac workup. Providers should be familiar with the ethical principles relevant to this dilemma in order to determine what is in the best interests of the patient.

  • acute coronary syndrome
  • chest - non trauma
  • ethics
  • clinical assessment

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  • Handling editor Richard Body

  • Contributors NWH, JPS and SAM drafted the manuscript. All authors contributed to the manuscript and substantially to its revision. NWH takes responsibility for the manuscript as a whole.

  • Funding There project was supported by the Wake Forest School of Medicine Department of Emergency Medicine.

  • Competing interests SAM receives research funding from Roche Diagnostics, Abbott Laboratories, Ortho Clinical Diagnostics, Creavo Medical Technologies, Siemens, Grifols, Pathfast, AHRQ, PCORI, NIDA and NHLBI (1RO1HL118263-01), and HRSA (1H2ARH399760100). He is a consultant for Roche and Amgen and the Chief Medical Officer for Impathiq Inc. JPS receives research funding from Abbott Laboratories and Roche Diagnostics.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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