Grijseels E W, Deckers J W, Hoes A W, Hartman J A, Van der Does E, Van Loenen E, Simoons M L
Thoraxcentre, Erasmus University Rotterdam, The Netherlands.
Eur Heart J. 1995 Mar;16(3):325-32. doi: 10.1093/oxfordjournals.eurheartj.a060914.
To evaluate previously developed algorithms for the improvement of pre-hospital triage of patients with suspected acute cardiac disease.
Prospective study.
Patients with symptoms of possible cardiac origin, who were seen by a general practitioner and subsequently referred to hospital in the municipality of Rotterdam.
Prior to hospital admission, patients with suspected acute coronary disease recorded their symptoms by standardized questionnaire and a computerized ECG was made. All patients were hospitalized and a final diagnosis was established. Algorithms proposed by other investigators to distinguish patients with, from those without, acute cardiac disease were tested.
Identification of patients whose likelihood for acute cardiac pathology was low (stable angina, atypical chest pain, other pathology) or high (myocardial infarction, unstable angina).
A total of 1005 patients were studied. Forty-two percent had myocardial infarction or unstable angina pectoris. Evaluation of previously developed algorithms showed that their diagnostic accuracy was poor in the pre-hospital setting. In a separate multivariate analysis, six characteristics from the clinical history and an electrocardiogram appeared to be independently and significantly associated with acute cardiac pathology. The presence of an abnormal ECG proved to be the most important predictor.
The hospital-based algorithms were unsuitable as a predictor for pre-hospital acute cardiac pathology. A new practical hospital admission model was developed, based on six clinical predictors, including analysis of an electrocardiogram. Following appropriate validation, this out-of-hospital protocol may lead to better triage decisions by the general practitioner.
评估先前开发的用于改善疑似急性心脏病患者院前分诊的算法。
前瞻性研究。
有可能源自心脏症状的患者，这些患者由全科医生诊治，随后被转诊至鹿特丹市的医院。
在入院前，疑似急性冠状动脉疾病的患者通过标准化问卷记录其症状，并进行电脑心电图检查。所有患者均住院治疗并确立最终诊断。对其他研究者提出的区分患有和未患有急性心脏病患者的算法进行测试。
识别急性心脏病变可能性低（稳定型心绞痛、非典型胸痛、其他病变）或高（心肌梗死、不稳定型心绞痛）的患者。
共研究了1005例患者。42%患有心肌梗死或不稳定型心绞痛。对先前开发的算法的评估表明，它们在院前环境中的诊断准确性较差。在一项单独的多变量分析中，临床病史和心电图的六个特征似乎与急性心脏病变独立且显著相关。心电图异常的存在被证明是最重要的预测因素。
基于医院的算法不适用于作为院前急性心脏病变的预测指标。基于包括心电图分析在内的六个临床预测因素，开发了一种新的实用的医院入院模型。经过适当验证后，这种院外方案可能会使全科医生做出更好的分诊决策。
