Brendan M. Reilly, MD; Arthur T. Evans, MD, MPH
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Reilly B., Evans A.; Assessment of Patients with Chest Pain. Ann Intern Med. 2004;141:325. doi: 10.7326/0003-4819-141-4-200408170-00023
Download citation file:
Published: Ann Intern Med. 2004;141(4):325.
TO THE EDITOR:
We agree with Goldman and Kirtane (1) that perfection is elusive in the triaging of patients with possible acute cardiac ischemia. Three questions may help to reframe this issue usefully, each emphasizing the untapped potential of Goldman's own research.
First, what should be the goal of our “search for perfection” in this area? Reducing the rate of missed myocardial infarction (MI) will always be important (2), but the more compelling outcome is the occurrence of life-threatening cardiac events in the few days following triage (3). Although incidence of these events is highest in patients with acute MI, more total events occur in patients without acute MI. Thus, if a principal goal of triage is to “increase the likelihood that patients are truly safe for discharge” (1), it will be important to move beyond the “rule out MI” paradigm and define safety with these and other important outcomes in mind (4).
to gain full access to the content and tools.
Learn more about subscription options.
Register Now for a free account.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only