Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm SE-182 88, Sweden.
Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm SE-171 77, Sweden.
J Am Med Inform Assoc. 2024 Jun 20;31(7):1529-1539. doi: 10.1093/jamia/ocae110.
In acute chest pain management, risk stratification tools, including medical history, are recommended. We compared the fraction of patients with sufficient clinical data obtained using computerized history taking software (CHT) versus physician-acquired medical history to calculate established risk scores and assessed the patient-by-patient agreement between these 2 ways of obtaining medical history information.
This was a prospective cohort study of clinically stable patients aged ≥ 18 years presenting to the emergency department (ED) at Danderyd University Hospital (Stockholm, Sweden) in 2017-2019 with acute chest pain and non-diagnostic ECG and serum markers. Medical histories were self-reported using CHT on a tablet. Observations on discrete variables in the risk scores were extracted from electronic health records (EHR) and the CHT database. The patient-by-patient agreement was described by Cohen's kappa statistics.
Of the total 1000 patients included (mean age 55.3 ± 17.4 years; 54% women), HEART score, EDACS, and T-MACS could be calculated in 75%, 74%, and 83% by CHT and in 31%, 7%, and 25% by EHR, respectively. The agreement between CHT and EHR was slight to moderate (kappa 0.19-0.70) for chest pain characteristics and moderate to almost perfect (kappa 0.55-0.91) for risk factors.
CHT can acquire and document data for chest pain risk stratification in most ED patients using established risk scores, achieving this goal for a substantially larger number of patients, as compared to EHR data. The agreement between CHT and physician-acquired history taking is high for traditional risk factors and lower for chest pain characteristics.
ClinicalTrials.gov NCT03439449.
在急性胸痛管理中，推荐使用风险分层工具，包括病史。我们比较了使用计算机化病史采集软件（CHT）获得的具有足够临床数据的患者比例与医生采集的病史，以计算既定风险评分，并评估这两种获取病史信息方式之间的患者间一致性。
这是一项前瞻性队列研究，纳入了 2017 年至 2019 年在瑞典斯德哥尔摩 Danderyd 大学医院就诊的年龄≥18 岁、因急性胸痛和非诊断性心电图及血清标志物就诊于急诊科的临床稳定患者。病史通过平板电脑上的 CHT 进行自我报告。风险评分中的离散变量观察结果从电子健康记录（EHR）和 CHT 数据库中提取。患者间一致性通过 Cohen's kappa 统计描述。
在纳入的 1000 例患者中（平均年龄 55.3±17.4 岁，54%为女性），HEART 评分、EDACS 和 T-MACS 可分别通过 CHT 计算 75%、74%和 83%，而通过 EHR 分别计算 31%、7%和 25%。CHT 与 EHR 的一致性为轻度至中度（kappa 值为 0.19-0.70），用于胸痛特征，为中度至几乎完美（kappa 值为 0.55-0.91），用于危险因素。
与 EHR 数据相比，CHT 可以使用既定的风险评分获取并记录大多数急诊科患者的胸痛风险分层数据，从而实现这一目标的患者数量要多得多。CHT 与医生采集病史之间的一致性对于传统危险因素较高，而对于胸痛特征则较低。
ClinicalTrials.gov NCT03439449。
Zotero 插件
