Kogan Asia, Shapira Reuma, Silman-Stoler Zmira, Rennert Gad
Emergency Department, Carmel Medical Center, Haifa, Israel.
Am J Emerg Med. 2003 Jan;21(1):68-70. doi: 10.1053/ajem.2002.34202.
The emergency physician's (EP) fast and correct diagnosis of patients with chest pain is crucial for preventing inappropriate discharge and dire consequences. To determine which factors affect admission decisions in the ED, we studied epidemiologic characteristics of both discharged and admitted patients, and the percentage of discharged patients who returned to the ED with acute myocardial infarction. The study included 185 patients seen in the ED because of chest pain between July 1 and 31, 1997 (every third day not included). Ninety patients were admitted: 36.7% were admitted for "observation of chest pain" and 63.3% met the criteria for active coronary heart disease. A form was used to collect personal data, medical history, risk factors, clinical examination, electrocardiogram interpretation, laboratory data, and admittance decision. EPs' diagnosis of cardiac chest pain demonstrated a sensitivity of 93.4%, a specificity of 73.4%, and a positive predictive value of 63.3%. Sensitivity for diagnosing acute myocardial infarct was 100%, with no erroneous discharges. The EP's ability to integrate the medical history information, including risk factors and pain characteristics, had a marked influence on the admittance decision. Efforts to reduce missed diagnoses are warranted.
急诊医生（EP）对胸痛患者进行快速、正确的诊断对于防止不恰当出院和严重后果至关重要。为了确定哪些因素影响急诊科的收治决策，我们研究了出院患者和收治患者的流行病学特征，以及因急性心肌梗死返回急诊科的出院患者百分比。该研究纳入了1997年7月1日至31日期间在急诊科因胸痛就诊的185例患者（不包括每隔三天的患者）。90例患者被收治：36.7%因“胸痛观察”被收治，63.3%符合活动性冠心病标准。使用一份表格收集个人资料、病史、危险因素、临床检查、心电图解读、实验室数据和收治决策。急诊医生对心脏性胸痛的诊断敏感性为93.4%，特异性为73.4%，阳性预测值为63.3%。诊断急性心肌梗死的敏感性为100%，无误诊出院情况。急诊医生整合病史信息（包括危险因素和疼痛特征）的能力对收治决策有显著影响。有必要努力减少漏诊。
