Schor S, Behar S, Modan B, Barell V, Drory J, Kariv I
JAMA. 1976 Aug 23;236(8):941-3.
All patients with presumed coronary problems seen at the Chaim Sheba Medical Center during a one-year period were followed up. The fate of those who were not hospitalized and the factors contributing to the two types of erroneous decisions, ie, refusing hospitalization to those needing it and unnecessary hospitalization of others, were evaluated. Approximately 50% of the patients were not admitted. Myocardial infarctions were later diagnosed in 6% of these patients. Another 8% were eventually categorized as other cardiac emergencies. Ten percent of all patients subsequently diagnosed as having myocardial infarctions were not admitted. On the other hand, 56% of the patients whose cases were later not considered to have been emergencies were hospitalized unnecessarily. Previous hospitalization for cardiac disease played a major role in making an error of both types. Other factors influencing the physician's decision regarding the patients' disposition included their age, sex, ethnic origin, and the findings from the emergency room electrocardiogram.
对一年内就诊于海姆·谢巴医疗中心、疑似患有冠状动脉疾病的所有患者进行了随访。评估了未住院患者的情况以及导致两种错误决策的因素，即拒绝收治需要住院的患者和让其他患者接受不必要的住院治疗。约50%的患者未被收治。这些患者中6%后来被诊断为心肌梗死。另有8%最终被归类为其他心脏急症。所有后来被诊断为心肌梗死的患者中有10%未被收治。另一方面，后来被认为并非急症的患者中有56%接受了不必要的住院治疗。既往有心脏病住院史在两种类型的错误决策中都起了主要作用。影响医生对患者处置决策的其他因素包括患者的年龄、性别、种族以及急诊室心电图检查结果。
