Herren K R, Mackway-Jones K, Richards C R, Seneviratne C J, France M W, Cotter L
Department of Emergency Medicine, Manchester Royal Infirmary, Manchester M13 9WL.
BMJ. 2001 Aug 18;323(7309):372. doi: 10.1136/bmj.323.7309.372.
To assess the clinical efficacy and accuracy of an emergency department based six hour rule-out protocol for myocardial damage.
Diagnostic cohort study.
Emergency department of an inner city university hospital.
383 consecutive patients aged over 25 years with chest pain of less than 12 hours' duration who were at low to moderate risk of acute myocardial infarction.
Serial measurements of creatine kinase MB mass and continuous ST segment monitoring for six hours with 12 leads.
Performance of the diagnostic test against a gold standard consisting of either a 48 hour measurement of troponin T concentration or screening for myocardial infarction according to the World Health Organization's criteria.
Outcome of the gold standard test was available for 292 patients. On the diagnostic test for the protocol, 53 patients had positive results and 239 patients had negative results. There were 18 false positive results and one false negative result. Sensitivity was 97.2% (95% confidence interval 95.0% to 99.0%), specificity 93.0% (90.0% to 96.0%), the negative predictive value 99.6%, and the positive predictive value 66.0%. The positive likelihood ratio was 13.9 and the negative likelihood ratio 0.03.
The six hour rule-out protocol for myocardial infarction is accurate and efficacious. It can be used in patients presenting to emergency departments with chest pain indicating a low to moderate risk of myocardial infarction.
评估基于急诊科的心肌损伤6小时排除方案的临床疗效和准确性。
诊断队列研究。
市中心一所大学医院的急诊科。
383例年龄超过25岁、胸痛持续时间少于12小时、急性心肌梗死风险低至中度的连续患者。
连续测量肌酸激酶MB质量,并使用12导联进行6小时的连续ST段监测。
根据由肌钙蛋白T浓度的48小时测量或根据世界卫生组织标准进行的心肌梗死筛查组成的金标准来评估诊断测试的性能。
292例患者可获得金标准测试的结果。在该方案的诊断测试中,53例患者结果为阳性,239例患者结果为阴性。有18例假阳性结果和1例假阴性结果。敏感性为97.2%(95%置信区间95.0%至99.0%),特异性为93.0%(90.0%至96.0%),阴性预测值为99.6%,阳性预测值为66.0%。阳性似然比为13.9,阴性似然比为0.03。
心肌梗死6小时排除方案准确且有效。它可用于因胸痛就诊于急诊科、提示心肌梗死风险低至中度的患者。