Performance and potential impact of a chest pain prediction rule in a large public hospital.
To evaluate the performance of a previously validated prediction rule for patients presenting to the emergency department with chest pain and the potential impact ofthe rule on triage decisions.
SUBJECTS AND METHODS
In a prospective cohort study, physician investigators interviewed consecutive patients admitted for suspected acute ischemic heart disease (n=207) by emergency department attending physicians who had not used the prediction rule.
We measured the accuracy of the rule in predicting cardiac complications in these patients, and compared actual triage decisions with those that might have been recommended by use of the prediction rule.
We also measured comorbid illnesses among patients stratified as very low risk by the prediction rule, as well as the effect of standardizing the definition of unstable angina and interpretation of electrocardiograms (ECG) on the rule's sensitivity and specificity.
Overall, the rate of major cardiac complications (4.3%) was similar to that reported in the original study (3.6%). The prediction rule performed well in predicting these complications in our patients (area under receiver operating characteristic curve 0.84 versus 0.80 in the original study ; difference 0.04,95% confidence interval [CI] - 0.07,0.14).
Standardized definitions of unstable angina and interpretation of ECGs improved the specificity of the prediction rule in predicting complications (55% versus 47% ; difference 8%, 95% CI 1.5%, 13.7%). (...)
Mots-clés Pascal : Angor instable, Hôpital général, Règle décision, Conduite à tenir, Facteur prédictif, Analyse coût efficacité, Evaluation, Homme, Etats Unis, Amérique du Nord, Amérique, Appareil circulatoire pathologie, Cardiopathie coronaire
Mots-clés Pascal anglais : Variant angina, General hospital, Decision rule, Clinical management, Predictive factor, Cost efficiency analysis, Evaluation, Human, United States, North America, America, Cardiovascular disease, Coronary heart disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0218873
Code Inist : 002B12A03. Création : 16/11/1999.