First 10EM - By Justin Morgenstern - August 7, 2019
..."So how good is gestalt in the diagnosis of acute coronary syndrome? A lot of people are already talking about this paper. Honestly, I don’t find the results all that exciting. I think it basically tells us what we already knew. It shouldn’t change anyone’s practice. However, I worry that the headlines will be misinterpreted in ways that could ultimately harm our patients. So let’s take a quick look to ensure we all understand what this study really shows.
The paper
Oliver G, Reynard C, Morris N, Body R. Can emergency physician gestalt “rule in” or “rule out” acute coronary syndrome: validation in a multi-center prospective diagnostic cohort study. Academic emergency medicine. 2019; PMID: 31338902 [article]
Bottom line
Don’t believe the rumours you might hear. Clinical judgement is enough to rule out ACS for many patients in the emergency department. Just don’t contradict yourself and try to use gestalt to rule out ACS in patients where your gestalt is that ACS is a possibility. That would be silly."