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A Journal on Forensic Medicine
Minerva Medicolegale 2010 March;130(1):35-45
The management of acute chest pain in hospital emergency departments: methods of clinical risk assessing and medicolegal aspects
Zaami S., Lauricella M. L., Marinelli E.
Dipartimento di Medicina Legale, Università degli Studi di Roma “Sapienza”, Roma, Italia
The management of patients with acute chest pain in hospital emergency departments is a current and contentious issue, also for the related medical-legal aspects due to a possible premature hospital discharge. It obviously requires a rapid diagnostic framework which recently was facilitated by drafting guidelines and indications promulgated by international scientific societies, which are actually widespread and applied on a large-scale, because also implemented by national and regional health institutions. Recently, the indications in scientific literature finalized at clinical decision on need of hospitalization and on detection of the treatment more timely and appropriate, was increased and advanced leading to identification of hazard classes based on predictive/prognostic criteria concerning the likelihood of the patient to have a major ischemic event. The authors analyze the evolution of indications on clinical decision, pointing out the negative effects of a blindly and uncritical acceptance and application in medical-legal context of these predictive/prognostic criteria which, if poorly applied, could lead to penalizing the medical conduct on the basis of a mere hypothetical risk, rather than in relation to actual damages caused to the patient.