Sixty-four cases of missed myocardial infarction in the emergency room were identified from the records of a major insurance company. The records were reviewed by three health care professionals using established standards of care for myocardial infarc tion. The diagnosis of myocardial infarction was missed in many cases due to the lack of diagnostic test ordering, poor interpretation of diagnostic tests, and the young age of the patients. Most patients were presented with symptoms compatible with myocar dial ischemia. There was an 83% mortality rate in the 64 cases. The cost of settlement and litigation far exceeded the cost of safe, effective, medical care in the cases studied.
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References
1.
Braunwald E., et al. Harrison's Principles of Internal Medicine, 11th ed., New York, McGraw-Hill, 1987.
2.
Braunwald E., et al. Heart Disease: A Textbook of Cardiovascular Medicine, 3rd ed. Philadelphia, Saunders, 1988.
3.
Lee TH, et al. Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room. Am J Cardiol1987;60:219-24.
4.
Goldman L., et al. A computer protocol to predict myocardial infarction in emergency department patients with chest pain. N Engl J Med1988;318:797-803.
5.
Pozen MW, et al. The usefulness of predictive instrument to reduce inappropriate admissions to the coronary care unit. Ann Intern Med1980;92:238-42.
