Patient with chest pain in the emergency room - will the computer resolve the physician's dilemma?

The detection of patients with different acute ischemic syndromes presenting to the emergency room with chest pain is a common daily diagnostic dilemma and challenge for the admitting emergency room physician. Physicians are finding it hard to identify immediately those patients truly afflicted with acute cardiac ischemia. Given the enormous number of patients presenting to the emergency room with chest pain, the admission of all patients with suspected acute cardiac ischemia in coronary care units (CCUs) has become unnecessary and wasteful of scarce and expensive CCU beds. To address this problem, hospitals have used computer-derived protocols based the combination of clinical profile and ECG findings to determine whether a patient should be admitted to the CCU. Such different computer approaches are described. In spite of these strategies, no single laboratory test can decidedly differentiate a well person from a sick one. The need of asking good questions and a careful examination remain imperative.