A COMPUTER-DERIVED PROTOCOL TO AID IN THE DIAGNOSIS OF EMERGENCY ROOM PATIENTS WITH ACUTE CHEST PAIN
A COMPUTER-DERIVED PROTOCOL TO AID IN THE DIAGNOSIS OF EMERGENCY ROOM PATIENTS WITH ACUTE CHEST PAIN
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DOI：
10.1056/nejm198209023071004
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发表时间：
1982-01-01
影响因子：
158.5
通讯作者：
STIRATELLI, R
中科院分区：
文献类型：
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作者：
GOLDMAN, L;WEINBERG, M;STIRATELLI, R
为了确定急诊室医生可用的数据是否能准确识别哪些急性胸痛患者患有心肌梗死，对482例患者进行了分析。采用递归划分分析，构建了基于9个临床因素的简单流程图决策方案来识别梗死。在第二家医院的468名其他患者的前瞻性测试中，该方案的表现与医生一样好。将该方案与医生的判断相结合，形成了一个分类系统，该系统保留了检测梗死的敏感性，显著提高了进入重症监护室的特异性（从67%提高到77%，P < 0.01）和阳性预测值（从34%提高到42%，P = 0.016）。该方案确定了一个由107名患者组成的亚组，其中只有5%的患者有梗死，对他们来说，进入非重症监护区可能是合适的。该决策方案需要进一步的大规模前瞻性试验，但尚未准备好常规临床应用。
To determine whether data available to physicians in the emergency room can accurately identify which patients with acute chest pain are having myocardial infarctions, 482 patients were analyzed. Using recursive partitioning analysis, a decision protocol in the format of a simple flow chart was constructed to identify infarction on the basis of 9 clinical factors. In prospective testing on 468 other patients at a 2nd hospital, the protocol performed as well as the physicians. An integration of the protocol with the physicians'' judgments resulted in a classification system that preserved sensitivity for detecting infarctions, significantly improved the specificity (from 67% to 77%, P < 0.01) and positive predictive value (from 34%-42%, P = 0.016) of admission to an intensive-care area. The protocol identified a subgroup of 107 patients among whom only 5% had infarctions and for whom admission to non-intensive care areas might be appropriate. This decision protocol warrants further wide-scale prospective testing but is not ready for routine clinical use.