CARE OF PATIENTS WITH A LOW PROBABILITY OF ACUTE MYOCARDIAL INFARCTION: AN ASSESSMENT
This research assesses a study by Fineberg, et al. (1984, pp. 1301 1307), concerning appropriate strategies for emergency room patients complaining of acute chest pain (only those patients not requiring intensive care for advanced arrhythmias or congestive heart failure were included in the analysis). The researchers drew their conclusions on the basis of a cost benefit analysis. Therefore, this assessment focuses on the study's application of cost benefit analysis. Specifically, this assessment considers the potential for built in bias in the study's quantification, the reliability of the study's findings, and what could have been done differently to improve the study, as well as an overall assessment of the study.
Although the maximum nurse/patient ratio assumed by the researchers for intermediate care units was twice that assumed for coronary care units, the researchers assumed that patients committed to intermediate care units would receive lidocaine to reduce ventricular fibrillation at a rate 75 percent that which would be received in a coronary care unit. With respect to successful resuscitation from primary ventricular fibrillation, the researchers assumed a half way point between the average in coronary care units and the rate for out of hospital resuscitations begun within five minutes of cardiac arrest. As a consequence of these assumptions, the researchers estimated that the probability of death from ventricular fibrillation in coronary care units at 0.00054 and the in intermediate care units
at 0.0033638. While the assumption related to successful resuscitation from primary ventricular fibrillation appears to have been reasonable, the assumption related to the probable use of lidocaine appears to be overstated by approximately 25 percent. If the lower probable rate of receiving lidocaine in intermediate care units had bee...