Porath A, Hilzenrat N, Risenberg K, Mashal A, Harman-Boehm I
Department of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Isr J Med Sci. 1994 Oct;30(10):737-41.
The risk of developing an acute coronary event (ACE) in patients presenting to the emergency room with chest pain or shortness of breath was assessed in a prospective blinded fashion. The Time Insensitive Predictive Instrument (TIPI), which is appropriate for both prospective and retrospective assessment, was used to determine the risk. The average predictive probability for developing ACE among the 168 patients examined was 36.5%. The triage process created groups of patients with significantly different relative risks for ACE. The average predictive probability among the patients discharged from the emergency room was 23%, among those hospitalized in internal medicine 44%, and among those hospitalized in the coronary care unit (CCU) 62.4%. Among patients presenting with ACE the predictive probability determined using TIPI was 57.6% compared to 26.3% in patients without ACE. This difference was unaffected by the triage process or the decision where to hospitalize. TIPI permits assessment of the emergency room physician's decisions and also mirrors the limitations of the system as a whole in treating patients referred to the emergency room for a suspected acute coronary event.
采用前瞻性盲法评估了因胸痛或呼吸急促前往急诊室就诊的患者发生急性冠状动脉事件（ACE）的风险。使用适用于前瞻性和回顾性评估的时间不敏感预测工具（TIPI）来确定风险。在接受检查的168例患者中，发生ACE的平均预测概率为36.5%。分诊过程将患者分为ACE相对风险显著不同的组。从急诊室出院的患者中，平均预测概率为23%，在内科住院的患者中为44%，在冠心病监护病房（CCU）住院的患者中为62.4%。在发生ACE的患者中，使用TIPI确定的预测概率为57.6%，而未发生ACE的患者为26.3%。这种差异不受分诊过程或住院决策的影响。TIPI可用于评估急诊室医生的决策，也反映了整个系统在治疗因疑似急性冠状动脉事件转诊至急诊室的患者时的局限性。
