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

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.