Missed myocardial infarctions in ED patients prospectively categorized as low risk by established risk scores
| Autor: | Peter A. McCullough, Stephen W. Smith, Henry C. Thode, William Arnold, C. de Filippi, Adam J. Singer, Robert H. Birkhahn, Tyler W. Barrett, Michael Reed, Lori B. Daniels, Gary F. Headden, Martin Than, William F. Peacock |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
Chest Pain medicine.medical_specialty Myocardial Infarction 030204 cardiovascular system & hematology Chest pain Risk Assessment Decision Support Techniques Electrocardiography 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Internal medicine Humans Medicine Prospective Studies cardiovascular diseases Myocardial infarction Prospective cohort study Finland health care economics and organizations medicine.diagnostic_test business.industry 030208 emergency & critical care medicine General Medicine Middle Aged medicine.disease Troponin Surgery Predictive value of tests Emergency Medicine Female Myocardial infarction diagnosis medicine.symptom Emergency Service Hospital business Risk assessment TIMI |
| Zdroj: | The American Journal of Emergency Medicine. 35:704-709 |
| ISSN: | 0735-6757 |
| DOI: | 10.1016/j.ajem.2017.01.003 |
| Popis: | Study objectives Few studies have prospectively compared multiple cardiac risk prediction scores. We compared the rate of missed acute myocardial infarction (AMI) in chest pain patients prospectively categorized as low risk by unstructured clinical impression, and by HEART, TIMI, GRACE, and EDACS scores, in combination with two negative contemporary cardiac troponins (cTn) available in the U.S. Methods We enrolled 434 patients with chest pain presenting to one of seven emergency departments (ED). Risk scores were prospectively calculated and included the first two cTn. Low risk was defined for each score as HEART≤3, TIMI≤0, GRACE≤50, and EDACS≤15. AMI incidence was calculated for low risk patients and compared across scores using Χ 2 tests and C statistics. Results The patients' median age was 57, 58% were male, 60% white, and 80 (18%) had AMI. The missed AMI rate in low risk patients for each of the scores when combined with 2 cTn were HEART 3.6%, TIMI 0%, GRACE 6.3%, EDACS 0.9%, and unstructured clinical impression 0%. The C-statistic was greatest for the EDACS score, 0.94 (95% CI, 0.92–0.97). Conclusions Using their recommended cutpoints and non high sensitivity cTn, TIMI and unstructured clinical impression were the only scores with no missed cases of AMI. Using lower cutpoints (GRACE≤48, TIMI=0, EDACS≤11, HEART≤2) missed no case of AMI, but classified less patients as low-risk. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect