Behar S, Schor S, Kariv I, Barell V, Modan B
Chest. 1977 Apr;71(4):486-91. doi: 10.1378/chest.71.4.486.
The contribution of the electrocardiogram to the clinical judgment used by the physician in the emergency room to determine the necessity for hospitalizing patients was evaluated. Thirty-five percent of all 1,578 patients with presumed myocardial infarction referred to the Chaim Sheba Medical Center, Tel Hashomer, Israel, for a one-year period had subsequently diagnosed myocardial infarctions. The ECG in the emergency room detected only 65 percent of these. The physician's clinical judgment was impressive in his decision to admit to the hospital almost all of the remaining 35 percent, while not admitting very many of the patients who did not have subsequently diagnosed myocardial infarctions. When the myocardial infarction was not evident on the ECG and the abnormalities on the tracings were identical for patients with subsequent myocardial infarctions and those without, again the physician made the right choice more often than the wrong. The follow-up ECG also attested to the good judgment of the physician in the emergency room. Of the emergency room ECGs of patients without subsequent myocardial infarctions who were admitted to the hospital, 17 percent showed myocardial infarction by follow-up, while this happened to only 2 percent of those denied admission.
评估了心电图对医生在急诊室用于判断患者是否需要住院的临床判断的贡献。在为期一年的时间里，以色列特拉维夫哈绍梅尔市海姆·谢巴医疗中心收治的1578例疑似心肌梗死患者中，有35%随后被确诊为心肌梗死。急诊室的心电图仅检测出其中的65%。医生的临床判断令人印象深刻，他几乎决定收治其余35%的患者入院，而对于那些后来未被确诊为心肌梗死的患者，收治的人数则很少。当心电图上心肌梗死不明显，且后续发生心肌梗死的患者与未发生心肌梗死的患者心电图异常相同时，医生做出正确选择的次数仍多于错误选择。随访心电图也证实了急诊室医生的良好判断力。在入院的未发生后续心肌梗死的患者中，17%的急诊室心电图在随访时显示为心肌梗死，而在未被收治的患者中，这一比例仅为2%。
