Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome
被引:1
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作者:
Hess, Erik P.
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机构:
Mayo Clin, Coll Med, Dept Emergency Med, Div Emergency Med Res, Rochester, MN 55905 USAMayo Clin, Coll Med, Dept Emergency Med, Div Emergency Med Res, Rochester, MN 55905 USA
Hess, Erik P.
[1
]
Perry, Jeffrey J.
论文数: 0引用数: 0
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机构:
Univ Ottawa, Dept Emergency Med, Ottawa, ON, Canada
Univ Ottawa, Dept Epidemiol & Community Med, Ottawa, ON, CanadaMayo Clin, Coll Med, Dept Emergency Med, Div Emergency Med Res, Rochester, MN 55905 USA
Perry, Jeffrey J.
[2
,3
]
Ladouceur, Pam
论文数: 0引用数: 0
h-index: 0
机构:
Univ Ottawa, Dept Emergency Med, Ottawa, ON, CanadaMayo Clin, Coll Med, Dept Emergency Med, Div Emergency Med Res, Rochester, MN 55905 USA
Ladouceur, Pam
[2
]
Wells, George A.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Ottawa, Dept Epidemiol & Community Med, Ottawa, ON, CanadaMayo Clin, Coll Med, Dept Emergency Med, Div Emergency Med Res, Rochester, MN 55905 USA
Wells, George A.
[3
]
Stiell, Ian G.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Ottawa, Dept Emergency Med, Ottawa, ON, Canada
Univ Ottawa, Dept Epidemiol & Community Med, Ottawa, ON, CanadaMayo Clin, Coll Med, Dept Emergency Med, Div Emergency Med Res, Rochester, MN 55905 USA
Stiell, Ian G.
[2
,3
]
机构:
[1] Mayo Clin, Coll Med, Dept Emergency Med, Div Emergency Med Res, Rochester, MN 55905 USA
[2] Univ Ottawa, Dept Emergency Med, Ottawa, ON, Canada
[3] Univ Ottawa, Dept Epidemiol & Community Med, Ottawa, ON, Canada
Objective: We derived a clinical decision rule to determine which emergency department (ED) patients with chest pain and possible acute coronary syndrome (ACS) require chest radiography. Methods: We prospectively enrolled patients over 24 years of age with a primary complaint of chest pain and possible ACS over a 6-month period. Emergency physicians completed standardized clinical assessments and ordered chest radiographs as appropriate. Two blinded investigators independently classified chest radiographs as "normal," "abnormal not requiring intervention" and "abnormal requiring intervention," based on review of the radiology report and the medical record. The primary outcome was abnormality of chest radiographs requiring acute intervention. Analyses included interrater reliability assessment (with kappa statistics), univariate analyses and recursive partitioning. Results: We enrolled 529 patients during the study period between Jul. 1, 2007, and Dec. 31, 2007. Patients had a mean age of 59.9 years, 60.3% were male, 4.0% had a history of congestive heart failure and 21.9% had a history of acute myocardial infarction. Only 2.1% (95% confidence interval [CI] 1.1%-3.8%) of patients had radiographic abnormality of the chest requiring acute intervention. The K statistic for chest radiograph classification was 0.81 (95% CI 0.66-0.95). We derived the following rule: patients can forgo chest radiography if they have no history of congestive heart failure, no history of smoking and no abnormalities on lung auscultation. The rule was 100% sensitive (95% CI 32.0%-40.4%) and 36.1% specific (95% CI 32.0%-40.4%). Conclusion: This rule has potential to reduce health care costs and enhance ED patient flow. It requires validation in an independent patient population before introduction into clinical practice.
机构:
Univ Manchester, Cardiovasc Sci Res Grp, Manchester, Lancs, EnglandUniv Manchester, Cardiovasc Sci Res Grp, Manchester, Lancs, England
McDowell, Garry
Pemberton, Philip
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机构:
Cent Manchester Univ Hosp Fdn NHS Trust, Emergency Dept, Manchester, Lancs, EnglandUniv Manchester, Cardiovasc Sci Res Grp, Manchester, Lancs, England
Pemberton, Philip
Burrows, Gillian
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机构:
Stockport NHS Fdn Trust, Stockport Hosp, Dept Biochem, Stockport, Lancs, EnglandUniv Manchester, Cardiovasc Sci Res Grp, Manchester, Lancs, England
Burrows, Gillian
Cook, Gary
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机构:
Stockport NHS Fdn Trust, Stockport Hosp, Dept Epidemiol, Stockport, Lancs, EnglandUniv Manchester, Cardiovasc Sci Res Grp, Manchester, Lancs, England
Cook, Gary
Lewis, Philip S.
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机构:
Stockport NHS Fdn Trust, Stockport Hosp, Dept Cardiol, Stockport, Lancs, EnglandUniv Manchester, Cardiovasc Sci Res Grp, Manchester, Lancs, England
Lewis, Philip S.
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机构:
Smith, Alexander
Mackway-Jones, Kevin
论文数: 0引用数: 0
h-index: 0
机构:
Cent Manchester Univ Hosp Fdn NHS Trust, Emergency Dept, Manchester, Lancs, England
Manchester Metropolitan Univ, Dept Hlth & Social Care, Manchester M15 6BH, Lancs, EnglandUniv Manchester, Cardiovasc Sci Res Grp, Manchester, Lancs, England
机构:
Mayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Mayo Clin, Div Emergency Med Res, Dept Emergency Med, Rochester, MN USAMayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Pierce, Meghan A.
Hess, Erik P.
论文数: 0引用数: 0
h-index: 0
机构:
Mayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Mayo Clin, Div Emergency Med Res, Dept Emergency Med, Rochester, MN USAMayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Hess, Erik P.
Kline, Jeffrey A.
论文数: 0引用数: 0
h-index: 0
机构:
Carolinas Med Ctr, Dept Emergency Med, Charlotte, NC 28203 USAMayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Kline, Jeffrey A.
Shah, Nilay D.
论文数: 0引用数: 0
h-index: 0
机构:
Mayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Mayo Clin, Dept Hlth Sci Res, Div Hlth Care Policy & Res, Rochester, MN USAMayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Shah, Nilay D.
Breslin, Maggie
论文数: 0引用数: 0
h-index: 0
机构:
Mayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Mayo Clin, Ctr Innovat, SPARC Design Studio, Rochester, MN USAMayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Breslin, Maggie
Branda, Megan E.
论文数: 0引用数: 0
h-index: 0
机构:
Mayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Mayo Clin, Dept Hlth Sci Res, Div Biomed Stat & Informat, Rochester, MN USAMayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Branda, Megan E.
Pencille, Laurie J.
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h-index: 0
机构:
Mayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USAMayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Pencille, Laurie J.
Asplin, Brent R.
论文数: 0引用数: 0
h-index: 0
机构:
Mayo Clin, Div Emergency Med Res, Dept Emergency Med, Rochester, MN USAMayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Asplin, Brent R.
Nestler, David M.
论文数: 0引用数: 0
h-index: 0
机构:
Mayo Clin, Div Emergency Med Res, Dept Emergency Med, Rochester, MN USAMayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Nestler, David M.
Sadosty, Annie T.
论文数: 0引用数: 0
h-index: 0
机构:
Mayo Clin, Div Emergency Med Res, Dept Emergency Med, Rochester, MN USAMayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Sadosty, Annie T.
Stiell, Ian G.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Ottawa, Dept Emergency Med, Ottawa, ON, CanadaMayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Stiell, Ian G.
Ting, Henry H.
论文数: 0引用数: 0
h-index: 0
机构:
Mayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Mayo Clin, Dept Internal Med, Div Cardiovasc Dis, Rochester, MN USAMayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Ting, Henry H.
Montori, Victor M.
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h-index: 0
机构:
Mayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
Mayo Clin, Dept Hlth Sci Res, Div Hlth Care Policy & Res, Rochester, MN USA
Mayo Clin, Dept Internal Med, Div Endocrinol Diabet Metab & Nutr, Rochester, MN USAMayo Clin, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA
机构:
Pontificia Univ Catolica Rio de Janeiro, Cardiol, Rio De Janeiro, Brazil
Inst Estadual Cardiol Aloysio de Castro, Sect Pesquisa Clin, Rio De Janeiro, BrazilPontificia Univ Catolica Rio de Janeiro, Cardiol, Rio De Janeiro, Brazil
Bassan, Roberto
Bassan, Fernando
论文数: 0引用数: 0
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机构:
Hosp Badin, Serv Cardiol, Rio De Janeiro, BrazilPontificia Univ Catolica Rio de Janeiro, Cardiol, Rio De Janeiro, Brazil
Bassan, Fernando
REVISTA DE LA FEDERACION ARGENTINA DE CARDIOLOGIA,
2011,
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