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April 1990

Statistical Medicine-Reply

Author Affiliations

Chattanooga, Tenn

Jacksonville, Fla

Arch Intern Med. 1990;150(4):921. doi:10.1001/archinte.1990.00390160160055

In Reply.—We appreciate the comments of Dr Burnside; however, we feel that the thrust of his arguments is misdirected. Our triage algorithm assumes, as have others, 1-5 that only patients with life-threatening complications clearly benefit from intensive care unit monitoring. Of the 57 low-risk patients, seven patients had four interventions, five non-life-threatening complications, and two myocardial infarctions. No intervention was emergent, and no life-threatening complication occurred in this group. Furthermore, of the two patients diagnosed as having an acute myocardial infarction, both had normal electrocardiograms on presentation, with only nondiagnostic ST-T changes appearing on serial electrocardiograms. Thus our low-risk group has a false-negative rate of 0% and not the 10% as stated in Dr Burnside's letter. While we agree that should the data be extended, life-threatening complications and/or death will ultimately occur in the low-risk group, the results to date indicate that this risk will be small.

Dr Burnside's