Critical Pathway for Chest Pain

Letters1 July 1998Critical Pathway for Chest PainThomas H. Lee, MD and Graham Nichol, MDThomas H. Lee, MDPartners Community Health Care, Inc.; Boston, MA 02199University of Ottawa; Ottawa, Ontario K1Y 4E9, CanadaSearch for more papers by this author and Graham Nichol, MDPartners Community Health Care, Inc.; Boston, MA 02199University of Ottawa; Ottawa, Ontario K1Y 4E9, CanadaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-129-1-199807010-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate that evidence of the potential role of rapid bedside testing in patients with chest pain in the emergency department is rapidly evolving. Dr. Bosch cites a non-experimental study of use of troponin-T and troponin-I. However, negative test results were insufficient to rule out short-term risks in all subgroups.The other studies that he cites are worth considering further. Lindahl and colleagues assessed troponin T in patients with crescendo angina or ischemia on electrocardiography. The sensitivity of troponin T was overestimated because testing was conducted up to 24 hours after symptom onset. Furthermore, another prospective study [1] ...References1. Brogan GX Jr, Hollander JE, McCuskey CF, Thode HC, Snow J, Sama A, et al. Evaluation of a new assay for cardiac troponin I vs creatine kinase-MB for the diagnosis of acute myocardial infarction. The Biochemical Markers for Acute Myocardial Ischemia (BAMI) Study Group. Acad Emerg Med. 1997; 4:6-12. Google Scholar2. Lachs MS, Nachamkin I, Edelstein PH, Goldman J, Feinstein AR, Schwartz JS. Spectrum bias in the evaluation of diagnostic tests: lessons from the rapid dipstick test for urinary tract infection. Ann Intern Med. 1992; 117:135-40. Google Scholar Author, Article, and Disclosure InformationAffiliations: Partners Community Health Care, Inc.; Boston, MA 02199University of Ottawa; Ottawa, Ontario K1Y 4E9, Canada PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 July 1998Volume 129, Issue 1Page: 70-71KeywordsEmergency departmentEvidence based medicineIschemiaMyocardial infarctionPatientsProspective studiesSpecificityTroponinTroponin TUnstable angina Issue Published: 1 July 1998 CopyrightCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...