Tierney W M, Roth B J, Psaty B, McHenry R, Fitzgerald J, Stump D L, Anderson F K, Ryder K W, McDonald C J, Smith D M
Crit Care Med. 1985 Jul;13(7):526-31. doi: 10.1097/00003246-198507000-00002.
To develop a decision rule to aid in the diagnosis of myocardial infarction, we evaluated clinical and ECG data on 540 adults treated in an urban hospital emergency room for acute chest pain. Of 62 (11.5%) patients who had acute infarctions, 54 were admitted to intensive care (sensitivity 87%); 103 of 478 patients without infarctions were also admitted to intensive care (specificity 78%). Thirty-four percent of all patients admitted had infarctions. Multivariate analysis identified only four clinical variables which carried independent information predicting infarction: two from the ECG and two from the clinical history. A predictive model based on these four variables had significantly greater specificity (86% vs. 78%, p = .003) and accuracy of overall patient classification (88% vs. 79%, p = .013) but somewhat lower sensitivity (81% vs. 87%, p = .46) than physician judgments. However, a decision rule which would have admitted to intensive care those patients with a high probability of infarction who were not admitted by the emergency room physicians, would have increased the sensitivity for detecting infarction to 95% with no appreciable decrease in specificity or yield of infarctions among patients admitted to intensive care.
为制定有助于诊断心肌梗死的决策规则，我们评估了在一家城市医院急诊室因急性胸痛接受治疗的540名成年人的临床和心电图数据。在62名（11.5%）发生急性梗死的患者中，54名被收入重症监护病房（敏感性87%）；在478名无梗死的患者中，103名也被收入重症监护病房（特异性78%）。所有入院患者中有34%发生了梗死。多变量分析仅确定了四个携带预测梗死独立信息的临床变量：两个来自心电图，两个来自临床病史。基于这四个变量的预测模型具有显著更高的特异性（86%对78%，p = .003）和总体患者分类准确性（88%对79%，p = .013），但敏感性略低于医生判断（81%对87%，p = .46）。然而，一个决策规则是将那些急诊室医生未收治的梗死可能性高的患者收入重症监护病房，这将使检测梗死的敏感性提高到95%，同时在收入重症监护病房的患者中，特异性或梗死检出率没有明显下降。
