title: Triage of patients with acute chest pain and possible cardiac ischemia: the elusive search for diagnostic perfection.
abstract: Few diagnostic decisions in medicine have been more heavily researched than the approach to the patient with acute chest pain. Despite the advances in both diagnosing and treating patients presenting with this symptom, cases of missed myocardial infarctions still cause substantial morbidity and mortality. This article examines a case in which a patient was sent home from the emergency department after presenting with chest pain and was subsequently found to have a myocardial infarction. In the context of the case, the article discusses clinical decision making about the diagnosis and triage of patients presenting with acute chest pain or with symptoms consistent with possible cardiac ischemia. A standardized approach to addressing the management of these patients is essential, given the adverse consequences of missing a life-threatening condition.
authors.affiliation: Department of Medicine, University of California, San Francisco, San Francisco, California 94143-0120, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Goldman
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
mesh_terms: D000368:Aged; D002140:California; D002637:Chest Pain / Q000209:etiology*; D003657:Decision Making; D003951:Diagnostic Errors; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006760:Hospitalization; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D014218:Triage / Q000592:standards*