TY - JOUR T1 - Highlights from this issue JF - Emergency Medicine Journal JO - Emerg Med J SP - 585 LP - 585 DO - 10.1136/emermed-2015-205195 VL - 32 IS - 8 AU - Paul Middleton Y1 - 2015/08/01 UR - http://emj.bmj.com/content/32/8/585.abstract N2 - Balancing diagnosis with risk is part of the intrinsic function of emergency medicine, recognising the reality that traditional strategies used by our colleagues do not always allow for the incidence of conditions which, although they may not fit into a clear diagnostic box, have the potential for devastating impact on a patient's health.Key amongst this group are the acute coronary syndromes, in which clinician gestalt has limited efficacy, routine tests only identify a proportion, and presenting complaints are variable and inconstant, particularly in some populations. The burden of the sheer numbers of patients is huge, with up to 10% of the 18 million patients each year through UK emergency departments potentially suffering from an ACS.In this issue, Gardner and colleagues investigate the relationship between raised admission blood glucose in the ED and major adverse cardiac events (MACE) up to 30 days post attendance. This study analysed data from the ASPECT trial, and found that patients with serum glucose above 7 mmol/l were one and a half times more likely to experience a MACE than those with glucose lower than 7. This was independent of a formal diagnosis of diabetes, and may be due … ER -