Prospective multicenter study of quantitative pretest probability assessment to exclude acute coronary syndrome for patients evaluated in emergency department chest pain units

Annals of Emergency Medicine
Alice M MitchellJeffrey A Kline

Abstract

We compare the diagnostic accuracy of 3 methods--attribute matching, physician's written unstructured estimate, and a logistic regression formula (Acute Coronary Insufficiency-Time Insensitive Predictive Instrument, ACI-TIPI)--of estimating a very low pretest probability (< or = 2%) for acute coronary syndromes in emergency department (ED) patients evaluated in chest pain units. We prospectively studied 1,114 consecutive patients from 3 academic EDs, evaluated for acute coronary syndrome. Physicians collected data required for pretest probability assessment before protocol-driven chest pain unit testing. A pretest probability greater than 2% was considered "test positive." The criterion standard was the outcome of acute coronary syndrome (death, myocardial infarction, revascularization, or > 60% stenosis prompting new treatment) within 45 days, adjudicated by 3 independent reviewers. Fifty-one of 1,114 enrolled patients (4.5%; 95% confidence interval [CI] 3.4% to 6.0%) developed acute coronary syndrome within 45 days, including 4 of 991 (0.4%; 95% CI 0.1% to 1.0%) patients, discharged after a negative chest pain unit evaluation result, who developed acute coronary syndrome. Unstructured estimate identified 293 patients with pre...Continue Reading

References

Mar 31, 1988·The New England Journal of Medicine·L GoldmanG Terranova
Jan 29, 1987·The New England Journal of Medicine·S G Pauker, J P Kassirer
Dec 1, 1981·Annals of Internal Medicine·H C SoxC H Sox
May 15, 1980·The New England Journal of Medicine·S G Pauker, J P Kassirer
Mar 1, 1997·Heart & Lung : the Journal of Critical Care·C DavisM Moscucci
Apr 28, 2000·Annals of Emergency Medicine·A B Storrow, W B Gibler
Jun 29, 2000·JAMA : the Journal of the American Medical Association·T G McGinnW S Richardson
May 26, 2001·Emergency Medicine Clinics of North America·G C Freas
Jul 4, 2001·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·N J WalkerJ E Hollander
Nov 3, 2001·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·L D Richardson, U Hwang
Feb 12, 2002·The American Journal of Medicine·Brendan M ReillyYue Wang
Jul 16, 2002·JAMA : the Journal of the American Medical Association·Brendan M ReillyEnrique Martinez
Jan 1, 2003·Clinical Chemistry·Patrick M BossuytUNKNOWN Standards for Reporting of Diagnostic Accuracy
Jun 9, 2004·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Jim ChristensonJoel Singer
Jan 7, 2005·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Robert J MarsanJudd E Hollander
Aug 13, 2005·BMC Medical Informatics and Decision Making·Jeffrey A KlineJ Lee Garvey

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Citations

May 4, 2012·Irish Journal of Medical Science·J GroarkeA O Maree
Aug 2, 2011·International Journal of Emergency Medicine·Jonathan S IlgenJ Stephen Bohan
May 26, 2006·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Alice M MitchellJeffrey A Kline
Jul 29, 2015·Annals of Emergency Medicine·Alexander T JankePhillip D Levy
Nov 3, 2010·The American Journal of Emergency Medicine·Andrea FabbriAlberto Vandelli
Apr 13, 2010·The Medical Clinics of North America·Anthony F T BrownMartin Than
Jun 30, 2009·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·Pamela S DouglasJames Udelson
Jul 7, 2009·Journal of Cardiovascular Computed Tomography·Pamela S DouglasJames Udelson
Nov 22, 2014·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Basmah SafdarDeborah B Diercks
Jul 14, 2014·Emergency Medicine Journal : EMJ·Richard BodyPhilip S Lewis
Sep 17, 2011·Journal of the American College of Cardiology·W Frank Peacock
May 31, 2008·Journal of the American College of Cardiology·W Franklin Peacock
Nov 19, 2011·American Heart Journal·W Frank PeacockDeborah Diercks
Dec 7, 2007·Atherosclerosis·Alberto Dominguez-RodriguezJuan Carlos Kaski
Jan 1, 2015·Journal of Diabetes and Metabolic Disorders·Akbar SoltaniFatemeh Shakki Katouli
Nov 9, 2016·The American Journal of Emergency Medicine·David M NestlerErik P Hess
Oct 4, 2016·The Journal of Emergency Medicine·Brit Long, Alex Koyfman
Nov 20, 2016·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Paul I Musey, Jeffrey A Kline
Dec 28, 2016·European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine·Alberto Bouzas-MosqueraJosé M Vázquez-Rodríguez
Dec 9, 2017·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Jason T SchafferNilay D Shah
Apr 13, 2012·Circulation. Cardiovascular Quality and Outcomes·Erik P HessVictor M Montori
Apr 8, 2010·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Jeffrey A KlineHoward A Smithline
Jun 17, 2011·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Jeremiah D SchuurBrent R Asplin
Nov 15, 2012·Critical Pathways in Cardiology·Francis M FesmireGregory W Heath
Nov 1, 2017·JCO Clinical Cancer Informatics·Travis JohnsonJames L Chen
Jan 1, 2018·The Canadian Journal of Cardiology·Marc A ProbstErik P Hess
May 3, 2021·Annals of Emergency Medicine·Steven M Green, David L Schriger
Dec 23, 2021·Emergency Medicine Journal : EMJ·Nicklaus P AshburnSimon A Mahler

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