Rollag A, Jonsbu J, Aase O, Erikssen J
Department of Internal Medicine, Central Hospital of Akershus, Nordbyhagen, Norway.
J Intern Med. 1992 Oct;232(4):299-304. doi: 10.1111/j.1365-2796.1992.tb00589.x.
A simple algorithm, which improves the diagnostic performance in patients arriving with acute chest pain in the emergency room, has been developed. The algorithm is solely based on information immediately available to the physician and includes elements from ECG, clinical findings and case history. As postulated, a stepwise use of all these variables improved the diagnostic accuracy and reduced the false positive cardiac-care unit (CCU) referral rate in a prospective study of 1450 patients admitted with acute chest pain. Compared to previous hospital practice during a preceding control period, sensitivity in diagnosing patients with unstable ischaemic heart diseases increased from 86% to 94% (P < 0.01), and specificity increased from 44% to 56% (P < 0.001). Accordingly, accuracy increased from 67% to 81% (P < 0.001), and false positive CCU-admission rate decreased from 35% to 19%. The greatest improvement in physician's diagnostic decisions was observed among patients without clear-cut signs of acute ischaemic heart disease on admission.
一种可提高急诊科急性胸痛患者诊断性能的简单算法已被开发出来。该算法完全基于医生可立即获取的信息，包括心电图、临床检查结果和病史等要素。正如所假设的那样，在一项对1450例因急性胸痛入院患者的前瞻性研究中，逐步使用所有这些变量提高了诊断准确性，并降低了心脏监护病房（CCU）的假阳性转诊率。与前一个对照期的医院既往做法相比，诊断不稳定型缺血性心脏病患者的敏感性从86%提高到了94%（P<0.01），特异性从44%提高到了56%（P<0.001）。相应地，准确性从67%提高到了81%（P<0.001），CCU假阳性入院率从35%降至19%。在入院时无明确急性缺血性心脏病体征的患者中，观察到医生诊断决策有最大改善。
