Chest pain assessment units allow safe early discharge of patients

Chest pain accounts for 2-4% of all new presentations to UK emergency departments. Around 70% of these patients are discharged, and evidence shows that 6% may have myocardial damage. On page 372 Herren et al describe the diagnostic performance of a six hour rule-out protocol for myocardial damage. They studied 383 patients with chest pain indicating a low to moderate risk of myocardial infarction and found that serial measurements of creatine kinase MB mass with continuous ST segment monitoring for six hours effectively ruled out myocardial damage. This protocol prevents the inappropriate discharge of patients and could reduce the number of admissions to hospital.

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Relevant Article

Is it possible to exclude a diagnosis of myocardial damage within six hours of admission to an emergency department? Diagnostic cohort study

K R Herren, K Mackway-Jones, C R Richards, C J Seneviratne, M W France, and L Cotter
BMJ 2001 323: 372. [Abstract] [Full Text] [PDF]