Prediction of the need for intensive care in patients who come to emergency departments with acute chest pain
Prediction of the need for intensive care in patients who come to emergency departments with acute chest pain
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DOI：
10.1056/nejm199606063342303
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发表时间：
1996-06-06
影响因子：
158.5
通讯作者：
Lee, TH
中科院分区：
文献类型：
--
作者：
Goldman, L;Cook, EF;Lee, TH
背景。因胸痛来到急诊室的患者是一个异质群体。有些人患有缺血性心脏病，可能会导致严重并发症，而另一些人则患有轻微疾病。我们进行了一项研究，以确定预测哪些患者将出现需要重症监护的并发症的临床因素。方法。我们首先研究了 1984 年至 1986 年间七家医院的 10,682 名急性胸痛患者（推导集），以确定主要并发症发生的潜在临床预测因素。然后，我们在 1990 年至 1994 年间一家医院的另一组 4676 名患者中验证了这些预测因素（验证集）。结果。在派生组患者中，我们确定了以下临床特征，如果出现在急诊科，则与并发症风险增加相关：心电图上的 ST 段抬高或 Q 波被认为表明急性心肌梗塞，其他心电图变化表明心肌缺血，收缩压低，肺部啰音或已知缺血性心脏病的恶化。根据这些标准，验证集中的患者是分为四组，前 12 小时内发生主要并发症的风险范围为 0.15% 至 8%，12 小时后，可根据患者是否已经发生过严重并发症、中等严重程度并发症或心肌梗死来更新发生主要并发症的概率（与既往没有并发症或心肌梗塞的患者相比，独立相对风险分别为 18.9、7.7 和 4.0）结论，急性胸痛患者发生主要并发症的风险可以根据临床表现和住院期间新的临床观察来估计。这些风险估计有助于对急性胸痛患者的适当医疗护理水平做出合理决定。 (C) 1996 年，马萨诸塞州医学会。
Background. Patients who come to the emergency department with chest pain are a heterogeneous group. Some have ischemic heart disease that may lead to serious complications, whereas others have minor disorders. We performed a study to identify clinical factors that predict which patients will have complications requiring intensive care.Methods. We first studied 10,682 patients with acute chest pain at seven hospitals between 1984 and 1986 (derivation set) to identify potential clinical predictors of the development of major complications, We then validated these predictors in a separate set of 4676 patients at one hospital between 1990 and 1994 (validation set).Results. In the derivation set of patients, we identified the following clinical features, which, if present in the emergency department, were associated with an increased risk of complications: ST-segment elevation or Q waves on the electrocardiogram thought to indicate acute myocardial infarction, other electrocardiographic changes indicating myocardial ischemia, low systolic blood pressure, pulmonary rales above the bases, or an exacerbation of known ischemic heart disease, On the basis of these criteria, the patients in the validation set were stratified into four groups, with the risk of major complications in the first 12 hours ranging from 0.15 to 8 percent, After 12 hours, the probability of a major complication could be updated on the basis of whether the patient had already had a complication of major severity, a complication of intermediate severity, or a myocardial infarction (independent relative risks, 18.9, 7.7, and 4.0, respectively, as compared with patients without prior complications or myocardial infarction).Conclusions, The risk of major complications in patients with acute chest pain can be estimated on the basis of the clinical presentation and new clinical observations made during the hospital course. These estimates of risk help in making rational decisions about the appropriate level of medical care for patients with acute chest pain. (C) 1996, Massachusetts Medical Society.