CHAPTER 17 MISSED ACS IN THE ED

Missed Diagnoses of Acute Cardiac Ischemia in the Emergency Department

Pope J, Aufderheide TP, Ruthazer R, et al. N Engl J Med. 2000;342(16):1163–1170

BACKGROUND

Chest pain is one of the leading chief complaints in the ED and acute coronary syndrome (ACS) is a complicated clinical diagnosis with significant medicolegal implications. The authors estimate that at the time of the study there were 1.1 million myocardial infarctions (MIs) annually with around 11,000 missed in the United States. However, there was no data on missed cases of unstable angina (UA). ACS frequently presents atypically and in patients without significant risk factors. Prior to this study there was very little information about how often emergency physicians missed MI and what the resulting consequences were.

OBJECTIVES

To evaluate how frequently ED providers failed to hospitalize patients ultimately diagnosed with ACS, including both MI and UA, and how this misdiagnosis affected mortality.

METHODS

Prospective study conducted in 10 academic and community EDs over 7 months in 1993.

Participants

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