According to a study, clinical judgment, combined with an electrocardiogram (ECG) and blood test on hospital arrival is effective in reducing unnecessary hospital admissions for chest pain.

Chest pain is the most common reason for emergency hospital admission. In the latest research, Richard Body from Manchester Royal Infirmary hospital, assessed the diagnostic accuracy of emergency doctors' clinical judgment for acute coronary syndromes - both alone and in combination with tests available on arrival like ECG and a blood test which detects a protein called troponin.

This data was then compared with patients' outcomes, including heart attack or the occurrence of major adverse cardiac events within 30 days. The results showed that for patients who are suspected to have an acute coronary syndrome (ACS), clinical judgment cannot be relied upon by itself to rule out or rule in that diagnosis.

However, when combined with an ECG and troponin test, clinical judgment appeared to be an effective tool and the results suggest that at least 25 percent of patient admissions could have been avoided.

The study suggested that this was the case regardless of whether the clinician was a consultant or junior doctor."If initial tests are normal and the doctor thinks that the diagnosis of a heart attack is unlikely, it may be perfectly safe to reassure patients that they do not have a heart attack," said Rick Body, honorary lecturer in cardiovascular medicine at University of Manchester.

The findings were published in the Emergency Medicine Journal.

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