Abstract
This study evaluates (a) the ability of house staff physicians to diagnose acute myocardial infarction (AMI) in patients with chest pain and (b) the usefulness of immediate (“stat”) creatine kinase determinations in aiding the decision to hospitalize patients with chest pain. Of 80 emergency room patients with chest pain, 34 were admitted to an intensive care unit and 46 were either discharged or admitted to a general medical unit. Of the 34 patients admitted to intensive care, 11 fulfilled criteria for AMI. Of the 46 who were not admitted, two met criteria for AMI: one had abnormal initial enzyme values; the other had normal initial values but diagnostic 48-hour values. Both had abnormal electrocardiograms. On the other hand, 11 patients who were not admitted had elevated initial enzyme values but did not have myocardial infarctions and might have been admitted inappropriately on the basis of their initial enzyme values. Five patients who were admitted had normal initial values but did develop infarctions and might have been sent home inappropriately on the basis of initial enzyme values. We conclude that: (a) physicians discharged 2 of 13 patients with AMI drawn from a population of 80 with chest pain and (b) the availability of stat cardiac enzymes could have prevented the discharge of only 1 patient and may have caused the inappropriate admission of 11 and discharge of 5 patients.
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Additional information
At the time this study was conducted, the authors were with the Departments of Medicine and Pathology, University of Pennsylvania, Philadelphia, Pennsylvania. Reprint requests should be addressed to Dr. Eisenberg, Silverstein 3, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104. Dr. Arvan's current address is Strong Memorial Hospital, Rochester, New York. Dr. Rawnsley's current address is Mary Hitchcock Memorial Hospital, Hanover, New Hampshire. This work was supported in part by the Clinical Scholars Program, Robert Wood Johnson Foundation, Princeton, N. J., by Training Grant A07AH00331 from the Public Health Service, and by the National Health Care Management Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania. The opinions, conclusions, and proposals in this text are those of the authors and do not necessarily represent those of the Robert Wood Johnson Foundation or the National Health Care Management Center. The authors acknowledge the valuable advice and cooperation of Drs. Samuel Martin, Joel Morganroth, and William Hanson, the staffs of the Hospital of the University of Pennsylvania emergency room and clinical laboratory, and the house staff who participated in this study.
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Eisenberg, J.M., Horowitz, L.N., Busch, R. et al. Diagnosis of acute myocardial infarction in the emergency room. J Community Health 4, 190–198 (1979). https://doi.org/10.1007/BF01322964
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DOI: https://doi.org/10.1007/BF01322964