Randomised controlled trial of chest pain units is needed

doi:10.1136/bmj.321.7265.896

BMJ 2000;321:896 ( 7 October )

Letters

Randomised controlled trial of chest pain units is needed

The first 150 words of the full text of this article appear below.

EDITOR $---$ Collinson et al audited prognostically important myocardial damage in patients discharged from the emergency department $---$ alarge and important healthcare problem.¹ The commentary byKennedy touches on several key issues as well as the obvious limitationsof such a study. As Kennedy says, further follow up data on theseven patients with raised concentrations of troponin would beuseful.

Kennedy also touched on the issue of definitions. The seven missed Mayday patients had myocardial damage but would not satisfythe definitions of acute myocardial infarction held by the WorldHealth Organization or the monitoring trends and determinantsin cardiovascular disease (MONICA) study. Collinson et al are,however, correct to point out that such patients have a less favourableprognosis. Should these classic definitions be reconsidered? The6% of discharged patients with troponin T concentrations above0.1 ng/ml have a substantial short term mortality and morbidity,²yet this can be . . . [Full text of this article]

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Prospective audit of incidence of prognostically important myocardial damage in patients discharged from emergency department • Commentary: Time for improved diagnosis and management of patients presenting with acute chest pain: P O Collinson, S Premachandram, K Hashemi, and R Lee Kennedy
BMJ 2000 320: 1702-1705. [Abstract] [Full Text] [PDF]