A TIME-INSENSITIVE PREDICTIVE INSTRUMENT IMPACT TRIAL

对时间不敏感的预测仪器影响试验

• 批准号: 2236043
• 负责人: Harry P. Selker
• 金额: $ 18.04万
• 依托单位: TUFTS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 1993
• 资助国家: 美国
• 起止时间: 1993-02-09 至 1995-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2236043
• 关键词: acute disease /disorder; angina pectoris; clinical trials; computer assisted medical decision making; coronary intensive care; electrocardiography; emergency care; health care service planning; heart disorder diagnosis; hospital utilization; human subject; medical complication; myocardial infarction; myocardial ischemia /hypoxia

The original acute cardiac ischemia (ACI) predictive instrument provides the ED clinician with a 0-100% probability value that a given patient has true ACI, i.e. either unstable angina pectoris or acute myocardial infarction (AMI), as an aid to decision-making for coronary care unit (CCU) admission. Our Multicenter ACI Predictive Instrument Trial (NCHSR/AHCPR # R01 HS02068) demonstrated a 30% reduction in CCU admissions for patients who did not have ACI, with no decrease in appropriate CCU admissions of patients with ACI. However, the original instrument's requirements for a hand-held calculator hampered its acceptance, and it was not applicable to retrospective case review. Our newer "ACI-TIPI" has several improvements. It is "time-insensitive", i.e. it provides the same probability value for a patient whether used in the real-time ED clinical setting or at a later time in medical record review. Its predictive performance has advantages over the original instrument that may help reduce inadvertent discharges of AMIs to home. In addition, incorporated into a computerized electrocardiograph so that the patient's probability of ACI and supporting text are automatically printed on the electrocardiogram header, it is much more attractive for use in the busy clinical setting (and can also be a vehicle for generating computerized feedback and clinical operations reports). The now-proposed TIPI Impact Trial aims to test, in a multicenter 17,500-patient controlled prospective clinical trial, the impact of the ACI-TIPI electrocardiograph on: 1) reducing unnecessary non-ACI CCU admissions; 2) reducing mistaken ED discharges to home of patients with ACI (especially AMI); 3) reducing the number of AMI-related complications by improved triage performance; 4) reducing time from ED presentation to triage; and 5) reducing time to the ED use of thrombolytic therapy for AMI. The structure and size of the trial and the diversity of its ten study site hospitals should yield valid and generalizable results. If successful, the trial will demonstrate an effective and easy-to-use method for improving the triage and treatment of the over five million patients per year presenting to U.S. EDs with symptoms suggestive of ACI and will provide a model of medical practice improvement applicable to many other clinical problems.

最初的急性心肌缺血(ACI)预测仪器提供 指定患者具有0-100%概率值的急诊临床医生 真正的急性心肌梗死，即不稳定心绞痛或急性心肌梗死 心肌梗死(AMI)，作为冠心病监护病房(CCU)决策的辅助手段 入场。我们的多中心ACI预测仪器试验(NCHSR/AHCPR# R01 HS02068)显示患者的CCU入院人数减少了30% 世卫组织没有ACI，CCU的适当入院人数没有下降 急性脑梗塞患者。然而，原始工具对 手持计算器阻碍了人们对它的接受，而且它不适用于 回溯性病例回顾。我们较新的“ACI-tipi”有几点改进。 它是“时间不敏感的”，即它为 患者无论是在实时急诊设置中使用还是在以后使用 病历审查的时间。它的预测性能具有优势 可能有助于减少意外排放的原始工具 阿米斯回家。此外，还纳入了一个计算机化的 心电图仪使患者发生ACI的概率和支持率 文字都是自动印在心电图头上的，很多 更适合在繁忙的临床环境中使用(也可以是 用于生成计算机化反馈和临床操作的工具 报告)。 现在提议的TIPI Impact试验旨在多中心进行测试 17,500名患者对照的前瞻性临床试验， ACI-TIPI心电图机：1)减少不必要的非ACI CCU 入院；2)减少急性脑梗塞患者错误的ED出院 (特别是急性心肌梗死)；3)通过以下方式减少急性心肌梗死相关并发症的数量 改进了分诊性能；4)缩短了从ED演示到 分流；以及5)缩短急诊室使用急性心肌梗死溶栓治疗的时间。 试验的结构和规模以及其十个研究地点的多样性 医院应该产生有效的和可推广的结果。 如果成功，试验将展示一种有效和易于使用的 提高500多万人分流救治水平的方法 每年向美国EDS报告的有ACI症状的患者 并将提供适用于许多人的医疗实践改进的模式 其他临床问题。