Iliceto Alessandro, Berndt Sara Louise, Greenslade Jaimi H, Parsonage William A, Hammett Christopher, Than Martin, Hawkins Tracey, Parker Kate, O'Kane Shannen, Cullen Louise
From the *Department of Emergency Medicine, and Department of Cardiology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; ‡School of Medicine, The University of Queensland, St. Lucia, QLD, Australia; ¶School of Public Health, Queensland University of Technology, Kelvin Grove, QLD, Australia; and ‖Christchurch School of Medicine, University of Otago, Christchurch, New Zealand.
Crit Pathw Cardiol. 2016 Sep;15(3):121-5. doi: 10.1097/HPC.0000000000000082.
Obtaining an accurate medical history is essential in the assessment of patients, particularly in emergency department (ED) patients with acute chest pain, as there can be a time imperative for diagnosis and commencement of treatment. We aimed to evaluate reliability of patient-reported compared with physician-adjudicated medical history by assessing patient's recall and communication of personal events and its influence on the accuracy of the medical history.
A total of 776 patients presenting at ED with suspected cardiac chest pain were recruited. Data collection included self-reported patient history, electrocardiogram testing, and troponin I measurements. Independent assessment of risk factors and medical history was adjudicated by cardiologists. Diagnosis of acute coronary syndrome (ACS) at 30 days after presentation was assessed. Cohen's kappa measured patient-cardiologist agreement. Cardiologist adjudicated events were taken as true to assess accuracy.
A total of 83 participants (10.7%) were diagnosed with ACS at 30 days after presentation. "Previous coronary artery bypass grafting" showed highest agreement (K = 1.00) between patient-reported and cardiologist-adjudicated events. Lowest agreement between patient-reported and cardiologist-adjudicated events was found for "prior ventricular dysrhythmia" (K = 0.33). Accuracy of reported "prior congestive heart failure" differed significantly between patients with and without diagnosed ACS at 30 days (92.8% and 97.5%, respectively).
Accuracy of patient's recall and communication of medical history and risk factors was substantial but not perfect in the assessment of patients with ACS in the ED context. Our study reinforces the importance in the utilization of medical records and collateral information to address possible discrepancies in the medical history and improve patient care.
获取准确的病史对于患者评估至关重要，尤其是对于急诊科（ED）中患有急性胸痛的患者，因为诊断和开始治疗可能存在时间紧迫性。我们旨在通过评估患者对个人事件的回忆和沟通情况及其对病史准确性的影响，来评估患者报告的病史与医生判定的病史的可靠性。
共招募了776名到急诊科就诊、疑似心脏性胸痛的患者。数据收集包括患者自我报告的病史、心电图检查和肌钙蛋白I测量。心脏病专家对危险因素和病史进行独立评估。评估就诊后30天的急性冠状动脉综合征（ACS）诊断情况。采用科恩kappa系数衡量患者与心脏病专家的一致性。以心脏病专家判定的事件为真实情况来评估准确性。
共有83名参与者（10.7%）在就诊后30天被诊断为ACS。“既往冠状动脉搭桥术”在患者报告的事件与心脏病专家判定的事件之间显示出最高的一致性（K = 1.00）。患者报告的事件与心脏病专家判定的事件之间一致性最低的是“既往室性心律失常”（K = 0.33）。在就诊后30天，已诊断和未诊断为ACS的患者中，报告的“既往充血性心力衰竭”的准确性存在显著差异（分别为92.8%和97.5%）。
在急诊科对ACS患者的评估中，患者对病史和危险因素的回忆及沟通准确性较高，但并不完美。我们的研究强化了利用病历和旁证信息以解决病史中可能存在的差异并改善患者护理的重要性。
