A COMPUTER PROTOCOL TO PREDICT MYOCARDIAL-INFARCTION IN EMERGENCY DEPARTMENT PATIENTS WITH CHEST PAIN
A COMPUTER PROTOCOL TO PREDICT MYOCARDIAL-INFARCTION IN EMERGENCY DEPARTMENT PATIENTS WITH CHEST PAIN
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DOI：
10.1056/nejm198803313181301
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发表时间：
1988-03-31
影响因子：
158.5
通讯作者：
JAKUBOWSKI, R
中科院分区：
文献类型：
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作者：
GOLDMAN, L;COOK, EF;JAKUBOWSKI, R
为了对急性胸痛患者进行更合适的冠状动脉护理病房分诊，我们使用了两家医院1379例患者的临床数据，构建了一个简单的计算机方案来预测心肌梗死的存在。当我们在两所大学医院和四所社区医院的4770名患者中对该方案进行前瞻性测试时，计算机衍生的方案在预测梗死是否存在方面具有明显更高的特异性（74%对71%），而不是医生决定是否让患者进入冠状动脉监护室，并且在检测梗死是否存在方面具有相似的敏感性（88.0对87.8%）。仅基于计算机协议的决策将使无梗死患者入院的冠状动脉监护室减少11.5%，而不会对出现紧急并发症需要重症监护的患者入院产生不利影响。尽管在个别病例中，该方案不应被用来取代仔细的临床判断，但计算机方案在大多数情况下可以准确估计心肌梗死的概率。根据该方案作出的关于进入冠状动脉护理病房的决定将与那些实际由照顾患者的独立医生做出的决定一样有效，而且成本更低。在没有进一步研究的情况下，接受治疗方案帮助的医生是否比未接受治疗的医生表现得更好还不能确定。
To achieve more appropriate triage to the coronary care unit of patients presenting with acute chest pain, we used clincial data on 1379 patients at two hospitals to construct a simple computer protocol to predict the presence of myocardial infarction. When we tested this protocol prospectively in 4770 patients at two university hospitals and four community hospitals, the computer-derived protocol had a significantly higher specificity (74 vs. 71 percent) in predicting the absence of infarction than physicians deciding whether to admit patients to the coronary care unit, and it had a similar sensitivity in detecting the presence of infarction (88.0 vs. 87.8 percent). Decisions based solely on the computer protocol would have reduced the admission of patients without infarction to the coronary care unit by 11.5 percent without adversely affecting the admission of patients in whom emergent complications developed that required intensive care. Although this protocol should not be used to override careful clinical judgment in individual cases, the computer protocol for the most part yields accurate estimates of the probability of myocardial infarction. Decisions about admission to the coronary care unit based on the protocol would have been as effective as those actually made by the unaided physicians who cared for the patients, and less costly. Whether physicians who are aided by the protocol perform better than unaided physicians cannot be determined without further study.