New test speeds diagnosis of chest pain

A study finds that in six quick steps emergency physicians can accurately identify or rule out a heart attack or warning signs of an impending heart attack that may occur within 30 days of a patient's visit to the emergency department for chest pain. (The Erlanger Chest Pain Evaluation Protocol: A One-Year Experience With Serial 12-Lead ECG Monitoring, Two-Hour Delta Serum Marker Measurements, and Selective Nuclear Stress Testing to Identify and Exclude Acute Coronary Syndromes, p. 584).

The six steps make up the Erlanger Chest Pain Protocol, which the study finds is accurate enough for emergency physicians to use for high- and low-risk patients. This prospective one-year study followed 2,074 emergency patients who sought care for chest pain at the Erlanger Medical Center in Chattanooga, Tenn., and underwent diagnosis using the protocol. The protocol proved to have a 100-percent sensitivity rating for heart attack and a 99.1-percent sensitivity for identification of patients with warning signs of impending heart attack.

Patients with abnormalities in any of the six steps were directly admitted to the hospital for further treatment and evaluation. The mean length of stay in the emergency department ranged from 2.5 to 7 hours depending on whether or not the patient underwent nuclear stress testing.

About 5 million Americans annually seek emergency care for chest pain and suspected acute coronary syndromes. With this new, accelerated evaluation tool, hospital admissions may be reduced and fewer patients with acute myocardial infarction or warning signs of impending myocardial infarction will be inadvertently discharged. Also, early diagnosis utilizing the protocol leads to earlier treatment thus improving patient outcomes.

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