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. 2000 Jun 24;320(7251):1702-5.
doi: 10.1136/bmj.320.7251.1702.

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

P O Collinson  1 , S Premachandram, K Hashemi
Affiliations

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

P O Collinson et al. BMJ. .

Abstract

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 microg/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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