Correct Diagnosis in Emergency Rooms

The study analyzed 4,136 patients with heart attack symptoms who were admitted to emergency departments (EDs) in eight U.S. centres. “One of the most common complaints we see in the Emergency Department is chest pain,” said Chadwick Miller, M.D., lead author and assistant professor of emergency medicine at Wake Forest Baptist.

The patients were divided into three groups: no myocardial infarction (No MI), non-ST segment elevation myocardial infarction (NSTEMI), or evolving myocardial infarction (EMI). The groups were determined by a blood test that measured levels of the protein troponin, which increases when the heart muscle is damaged from a heart attack.

Patients classified as No MI may have had symptoms but, according to the troponin levels throughout their hospital stay, did not actually have a heart attack. Patients classified as NSTEMI showed elevated troponin levels when first admitted, usually because their heart attack happened several hours or even days before coming to the ED. Patients classified as EMI did not initially show elevated troponin levels when presenting to the ED, but showed evidence of heart damage up to 12 hours later.

The study focused primarily on EMI patients. When a patient was admitted into the ED with heart attack symptoms, doctors would record their initial impressions of the symptoms exhibited by the patient. According to the results, the initial impression of the physicians showed that a higher percentage of them assigned a higher risk of heart attack to the EMI (76 percent) and NSTEMI (71 percent) patients, than the No MI (52 percent) group. As a result, the EMI patients were triaged to higher levels of care than the no MI group, despite the initial negative troponin results.

This study suggests that although we are relying on better medical technology to diagnose patients, the clinical impression is still very important.”

MEDICA.de; Source: Wake Forest University Baptist Medical Center