Influence of pseudodiagnostic information on the evaluation of ischemic heart disease.

STUDY OBJECTIVES

To measure the influence of classic epidemiologic risk factors (as recorded on the chart) on physicians' admission decisionmaking for patients with suspected acute cardiac ischemia and to compare the influence of those risk factors, which are of limited predictive utility, to the influence of predictively useful information.

DESIGN

Retrospective chart review.

SETTING

Emergency departments of two community hospitals.

PARTICIPANTS

Seven hundred eighty-seven patients evaluated for suspected acute cardiac ischemia, whether admitted or not.

RESULTS

Logistic regression revealed that the effect of a recorded history of hypertension on the admission decision (OR, 7.89; 95% CI, 4.57 to 13.58) was greater than that for ST-segment changes on the ECG (OR, 3.98; 95% CI, 2.56 to 6.18) or history of infarction (OR, 2.36; 95% CI, 1.53 to 3.62). A recorded history of diabetes had a small effect (OR, 1.84; 95% CI, 1.01 to 3.36), whereas Q waves and T-wave changes were not statistically significant.

CONCLUSION

Physicians' admission decisions appeared to be more heavily influenced by pseudodiagnostic information than by information of objective predictive power. Physicians do not appear to distinguish risk factors from diagnostic information; education may be directed at this distinction.