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Comment & Response
April 2018

Incorrect Conclusions of a Secondary Analysis—Reply

Author Affiliations
  • 1Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Health Care Policy and Law Editor, JAMA Internal Medicine
JAMA Intern Med. 2018;178(4):582. doi:10.1001/jamainternmed.2018.0187

In Reply Hoffmann et al state that my Editor’s Note1 failed to point out major flaws in the Original Investigation by Reinhardt et al.2 Using data from the ROMICAT II trial (NCT01084239), the study by Reinhardt et al2 compared low-to-intermediate risk patients admitted to the emergency department with chest pain who received noninvasive testing with those who did not receive testing. Yet, I clearly stated that, “While the findings are suggestive that testing may safely be omitted in such patients, the results are not definitive. The study was not designed or powered to address this question, and patients were not randomized to testing or no testing.”1(p220) I went on to suggest that the study by Reinhardt et al2 should motivate a randomized clinical trial. Despite the limitations of the secondary analysis by Reinhardt et al,2 the results are noteworthy and add to a growing literature that noninvasive testing may not be routinely necessary in low-to-intermediate risk patients presenting to the ED with chest pain. While we await a randomized clinical trial on this important question, clinicians need to apply sound judgment in identifying patients in whom noninvasive testing may be safely omitted.

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