BMJ 2000;320:1702-1705 ( 24 June )

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Prospective audit of incidence of prognostically important myocardial damage in patients discharged from emergency department

P O Collinson, consultant chemical pathologist, ^a S Premachandram, specialist registrar, ^b K Hashemi, consultant in accident and emergency medicine. ^b

^a Department of Chemical Pathology, Mayday University Hospital, Croydon CR7 7YE, ^b Department of Accident and Emergency Medicine, Mayday University Hospital

Correspondence to: P O Collinson, Department of Clinical Biochemistry, 2nd Floor, Jenner Wing, St George's Hospital, London SW17 0QT poctrop{at}poctrop.demon.co.uk

Objective: To assess the incidence of prognostically important myocardial damage in patients with chest pain discharged from the emergency department.
Design: Prospective observational study.
Setting: District general hospital emergency department.
Participants: 110 patients presenting with chest pain of unknown cause who were subsequently discharged home after cardiac causes of chest pain were ruled out by clinical and electrocardiographic investigation.
Interventions: Patients were reviewed 12-48 hours after presentation by repeat electrocardiography and measurement of cardiac troponin T.
Main outcome measures: Incidence of missed myocardial damage.
Results: Eight (7%) patients had detectable cardiac troponin T on review and seven had concentrations 0.1 µg/l. The repeat electrocardiogram showed no abnormality in any patient.
Conclusion: 6% of the patients discharged from the emergency department had missed prognostically important myocardial damage. Follow up measurement of cardiac troponin T allows convenient audit of clinical performance in the emergency department.

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