Study: Emergency department MDs should trust 'gut instincts'

A new study looking at how emergency department physicians evaluate patients with chest pains suggests that they should trust their "gut instincts" more often, according to author Abhinav Chandra, M.D., director of acute care research and clinical evaluation at Duke University Medical Center.

To test his hypothesis that ED physicians often get it right about heart patients, he designed a study relying on data from an earlier heart attack research effort gathering data from nine different hospitals. The trial recorded patient symptoms, EKG findings, lab tests and doctors' impressions. The physicians had also completed EKGs and other diagnostic tests.

Dr. Chandra's data included 10,713 patient who had participated in the original study. Of that group, 604 were diagnosed with unstable angina, and 133, or 22 percent, had an adverse outcome in the first 30 days after being admitted to the hospital.

Meanwhile, Dr. Chandra and colleagues examined data on 24 patients discharged from the ED who had major adverse cardiac events, of a total of 5,224 sent home from the group assessed as "high risk." Five of the 24 patients had a major adverse outcome within the first 30 days.

While only 1 percent of discharged patients had an adverse outcome within the first 30 days, that's still too many, Dr. Chandra suggests, as ED physicians had clearly expressed concern about their well being. To avoid this problem, hospitals could benefit from establishing a chest pain observation unit to further screen patient for heart risk.

To learn more about this study:
- read this piece

The study summarizing Dr. Chandra's findings is published this month in the journal Academic Emergency Medicine.