Pozen M W, D'Agostino R B, Mitchell J B, Rosenfeld D M, Guglielmino J T, Schwartz M L, Teebagy N, Valentine J M, Hood W B
Ann Intern Med. 1980 Feb;92(2 Pt 1):238-42. doi: 10.7326/0003-4819-92-2-238.
A mathematical instrument was developed to supplement the diagnostic information available to physicians in the emergency room to improve physicians' diagnostic accuracy in managing patients with acute ischemic heart disease and thereby reduce inappropriate coronary care unit admissions. The instrument was empirically derived and is based on nine clinical, historical, and electrocardiographic predictive variables. Probabilities of acute ischemic heart disease generated by the instrument were given to the house staff in an emergency room during alternate months. Comparison of the control months (455 patients) with the experimental months (401 patients) showed the following: The overall diagnostic accuracy increased from 83% to 91% (P less than 0.005), the overdiagnostic accuracy increased from 51% to 33% (P less than 0.01), and the admission rate to the coronary care unit fell from 26% to 14% (P less than 0.001), while the inappropriate discharge rate from the emergency room did not change, 3% versus 3% (not significant).
开发了一种数学工具，以补充急诊室医生可获得的诊断信息，提高医生对急性缺血性心脏病患者的诊断准确性，从而减少不适当的冠心病监护病房入院人数。该工具是根据经验得出的，基于九个临床、病史和心电图预测变量。在交替的月份里，将该工具生成的急性缺血性心脏病概率提供给急诊室的住院医生。对对照月份（455例患者）和实验月份（401例患者）进行比较，结果如下：总体诊断准确率从83%提高到91%（P<0.005），过度诊断准确率从51%降至33%（P<0.01），冠心病监护病房的入院率从26%降至14%（P<0.001），而急诊室的不适当出院率没有变化，分别为3%和3%（无统计学意义）。
