Westfall John M, Van Vorst Rebecca F, McGloin Joe, Selker Harry P
University of Colorado Health Sciences Center, UCHSC at Fitzsimons, Aurora, Colo, USA.
Ann Fam Med. 2006 Mar-Apr;4(2):153-8. doi: 10.1370/afm.403.
The Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI) has been shown to improve diagnostic accuracy of acute cardiac ischemia (ACI) and decrease coronary care unit admissions in urban emergency departments. The purpose of this study was to determine the impact of the ACI-TIPI on triage and diagnosis of patients with chest pain in rural hospitals.
We undertook a controlled trial of the impact ACI-TIPI use in the High Plains Research Network (HPRN). Main outcome measures were the triage of patients in emergency departments (admission, transfer, or discharge home) and diagnostic accuracy.
There were 1,861 patients seen during a 10-month period. Forty-five percent of all patients complaining of chest pain were discharged home from the emergency department. Eight percent were transferred from the emergency department, and another 10% were transferred later after admission. Among patients with acute myocardial infarction or unstable angina, 22.2% were transferred directly from the emergency department and only 3% were discharged home when ACI-TIPI was available, compared with 18.7% transferred and 5.2% discharged home when not available (P = .4). Diagnostic accuracy was high and not statistically different with the addition of the ACI-TIPI score (86.8% ACI-TIPI off vs 89.0% ACI-TIPI on, P = .15),
Physicians in the HPRN provided appropriate diagnosis and triage to patients with chest pain. Routine addition of the ACI-TIPI score did not improve diagnostic accuracy or significantly change triage. Further research on ACI-TIPI in rural hospitals is necessary before recommending routine use of the ACI-TIPI.
急性心脏缺血时间不敏感预测工具（ACI-TIPI）已被证明可提高急性心脏缺血（ACI）的诊断准确性，并减少城市急诊科冠心病监护病房的入院人数。本研究的目的是确定ACI-TIPI对农村医院胸痛患者分诊和诊断的影响。
我们在高平原研究网络（HPRN）中进行了一项关于使用ACI-TIPI影响的对照试验。主要结局指标是急诊科患者的分诊（入院、转院或出院回家）和诊断准确性。
在10个月期间共诊治了1861例患者。所有主诉胸痛的患者中有45%从急诊科出院回家。8%的患者从急诊科转院，另有10%的患者在入院后转院。在急性心肌梗死或不稳定型心绞痛患者中，当有ACI-TIPI时，22.2%的患者直接从急诊科转院，只有3%的患者出院回家；而在没有ACI-TIPI时，分别为18.7%转院和5.2%出院回家（P = 0.4）。诊断准确性较高，添加ACI-TIPI评分后无统计学差异（ACI-TIPI未使用时为86.8%，使用时为89.0%，P = 0.15）。
HPRN的医生对胸痛患者进行了适当的诊断和分诊。常规添加ACI-TIPI评分并未提高诊断准确性或显著改变分诊。在建议常规使用ACI-TIPI之前，有必要对农村医院的ACI-TIPI进行进一步研究。
