Goldman L, Cook E F, Brand D A, Lee T H, Rouan G W, Weisberg M C, Acampora D, Stasiulewicz C, Walshon J, Terranova G
Joint Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
N Engl J Med. 1988 Mar 31;318(13):797-803. doi: 10.1056/NEJM198803313181301.
To achieve more appropriate triage to the coronary care unit of patients presenting with acute chest pain, we used clinical data on 1379 patients at two hospitals to construct a simple computer protocol to predict the presence of myocardial infarction. When we tested this protocol prospectively in 4770 patients at two university hospitals and four community hospitals, the computer-derived protocol had a significantly higher specificity (74 vs. 71 percent) in predicting the absence of infarction than physicians deciding whether to admit patients to the coronary care unit, and it had a similar sensitivity in detecting the presence of infarction (88.0 vs. 87.8 percent). Decisions based solely on the computer protocol would have reduced the admission of patients without infarction to the coronary care unit by 11.5 percent without adversely affecting the admission of patients in whom emergent complications developed that required intensive care. Although this protocol should not be used to override careful clinical judgment in individual cases, the computer protocol for the most part yields accurate estimates of the probability of myocardial infarction. Decisions about admission to the coronary care unit based on the protocol would have been as effective as those actually made by the unaided physicians who cared for the patients, and less costly. Whether physicians who are aided by the protocol perform better than unaided physicians cannot be determined without further study.
为了对急性胸痛患者进行更恰当的分诊以收入冠心病监护病房，我们利用两家医院1379例患者的临床数据构建了一个简单的计算机程序来预测心肌梗死的存在。当我们在两家大学医院和四家社区医院对4770例患者进行前瞻性测试时，计算机生成的程序在预测无梗死方面的特异性（74%对71%）显著高于负责决定是否将患者收入冠心病监护病房的医生，并且在检测梗死存在方面具有相似的敏感性（88.0%对87.8%）。仅基于计算机程序做出的决策可使无梗死患者进入冠心病监护病房的比例降低11.5%，而不会对出现需要重症监护的紧急并发症的患者入院产生不利影响。虽然该程序不应被用于推翻个别病例中的审慎临床判断，但计算机程序在很大程度上能准确估计心肌梗死的概率。基于该程序做出的关于收入冠心病监护病房的决策与照顾患者的未借助辅助的医生实际做出的决策同样有效，且成本更低。在没有进一步研究的情况下，无法确定借助该程序的医生是否比未借助辅助的医生表现更好。
