Pope et al identified risk factors for failing to diagnose patients presenting to the emergency department with either acute myocardial infarction or unstable angina. These patients are at risk for increased morbidity and mortality if discharged. The authors are from New England Medical Center, Baystate Medical Center, Medical College of Wisconsin, Rhode Island Hospital and Boston Medical Center.
Patient selection: acute myocardial infarction or unstable angina
Risk factors for failure to diagnose:
(1) chief complaint shortness of breath
(2) woman < 55 years of age
(3) normal or nondiagnostic ECG
(4) non-White race
Other risk factors that may contribute to a failure to diagnose:
(1) atypical symptoms other than shortness of breath (congestive heart failure, abdominal pain)
(2) failure to detect subtle ST-segment elevations (1-2 mm)
(3) non-Q-wave infarct
where:
• It might be interesting to see how many of these patients had another plausible explanation for the symptoms, did not have insurance, or were unwilling to stay.
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