Chest Pain in the ED

iStock_000016798528_MediumWhen someone comes to the emergency department complaining of chest pain, a heart attack or other heart issue comes immediately to mind and a host of assessments ensue, often resulting in admission to the hospital.  Is that really necessary after negative findings in the ED?  That's one study Rick and I discuss on PodMed this week, as published in JAMA Internal Medicine.  The authors took a look at over 45,000 enrollees in a database collecting information from adult patients complaining of chest pain and with negative biomarkers for heart problems.  When these patients were admitted to the hospital, how often did heart attack, arrhythmia, cardiac or respiratory arrest or death occur?  An astonishingly low 0.06% of the time, or 4 out of 7266 patients, with 2 of those events a consequence of hospitalization.  Sure seems like not admitting these folks to the hospital is a reasonable strategy, but Rick and I agree that because of physician attitudes may take quite some time to penetrate clinical practice.

Other topics this week include a new treatment for asthma in NEJM, sciatica and steroids in JAMA, and in the Lancet, consequences of treatment with lithium.  Until next week, y'all live well.

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