MacGougan C K, Christenson J M, Innes G D, Raboud J
Queen's University, Kingston, Ontario, Canada.
CJEM. 2001 Apr;3(2):89-94. doi: 10.1017/s1481803500005303.
To determine Canadian emergency physicians' estimates regarding the safety and efficiency of chest discomfort management in their emergency department (ED), and their attitudes toward and perception of the need for a chest discomfort clinical prediction rule that identifies very low risk patients who are safe to discharge after a brief ED assessment.
300 members of the Canadian Association of Emergency Physicians (CAEP) were randomly selected to receive a confidential mail survey, which invited them to provide information on current disposition of patients with chest discomfort and their opinions regarding the value of a clinical prediction rule to identify patients with chest discomfort who are safe to discharge after a brief (approximately 2 hour) assessment.
Of the 300 physicians selected, 288 were eligible for the survey and 235 (82%) responded. Only 5% follow discharged patients to measure safe practice. Overall, 165 (70%) felt the proposed prediction rule would be very useful and 43 (18%) felt it would be useful. Almost all (94%) believed a prediction rule would be useful if it identified patients safe for discharge without increasing the current rate of missed acute myocardial infarction (estimated at 2%). Most respondents (59%) believed that a clinical prediction rule should suggest a course of action, while 30% felt it should convey a probability of disease.
Canadian emergency physicians support the concept of a clinical prediction rule for the early discharge of patients with chest discomfort. Most believe that such a rule would be useful if it identified patients who are safe for discharge after a brief assessment, while maintaining current levels of safety. Future research should be aimed at deriving a clinical prediction rule to identify low risk patients who can be safely discharged after a limited emergency department evaluation.
确定加拿大急诊医生对其急诊科胸痛不适管理的安全性和效率的估计，以及他们对胸痛不适临床预测规则的态度和对其必要性的认知，该规则用于识别在急诊科进行简短评估后可安全出院的极低风险患者。
随机选择300名加拿大急诊医师协会（CAEP）成员进行保密邮件调查，邀请他们提供有关胸痛不适患者当前处置情况的信息，以及他们对临床预测规则价值的看法，该规则用于识别在进行简短（约2小时）评估后可安全出院的胸痛不适患者。
在所选的300名医生中，288名符合调查条件，235名（82%）做出了回应。只有5%的医生对出院患者进行随访以衡量安全实践情况。总体而言，165名（70%）认为拟议的预测规则会非常有用，43名（18%）认为会有用。几乎所有（94%）的人认为，如果预测规则能识别出可安全出院的患者且不增加当前急性心肌梗死漏诊率（估计为2%），那么该规则将是有用的。大多数受访者（59%）认为临床预测规则应建议采取行动方案，而30%的人认为它应传达疾病发生概率。
加拿大急诊医生支持胸痛不适患者早期出院的临床预测规则概念。大多数人认为，如果这样的规则能识别出在简短评估后可安全出院的患者，同时保持当前的安全水平，那么它将是有用的。未来的研究应旨在得出一个临床预测规则，以识别在急诊科进行有限评估后可安全出院的低风险患者。
