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

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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 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. 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.