Each year 1.5 million patients are admitted to coronary-care units (CCUs) for suspected acute ischemic heart disease; for half of these, the diagnosis is ultimately "ruled out." In this study, conducted in the emergency rooms of six New England hospitals ranging in type from urban teaching centers to rural nonteaching hospitals, we sought to develop a diagnostic aid to help emergency room physicians reduce the number of their CCU admissions of patients without acute cardiac ischemia. From data on 2801 patients, we developed a predictive instrument for use in a hand-held programmable calculator, which requires only 20 seconds to compute a patient's probability of having acute cardiac ischemia. In a prospective trial that included 2320 patients in the six hospitals, physicians' diagnostic specificity for acute ischemia increased when the probability value determined by the instrument was made available to them. Rates of false-positive diagnosis decreased without any increase in rates of false-negative diagnosis. Among study patients with a final diagnosis of "not acute ischemia," the number of CCU admissions decreased 30 per cent, without any increase in missed diagnoses of ischemia. The proportion of CCU admissions that represented patients without acute ischemia dropped from 44 to 33 per cent. Widespread use of this predictive instrument could reduce the number of CCU admissions in this country by more than 250,000 per year.
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Herring, N., Paterson, D.J.
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[Abstract][Full Text]
Kennedy, R L, Harrison, R F
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[Abstract][Full Text]
Lai, F., Macmillan, J., Daudelin, D. H., Kent, D. M.
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[Abstract]
Swap, C. J., Nagurney, J. T.
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[Abstract][Full Text]
White, C. S., Kuo, D., Kelemen, M., Jain, V., Musk, A., Zaidi, E., Read, K., Sliker, C., Prasad, R.
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[Abstract][Full Text]
Garg, A. X., Adhikari, N. K. J., McDonald, H., Rosas-Arellano, M. P., Devereaux, P. J., Beyene, J., Sam, J., Haynes, R. B.
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[Abstract][Full Text]
Abadie, J. M., Blassingame, C. L., Bankson, D. D.
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[Abstract][Full Text]
Goodacre, S., Nicholl, J., Dixon, S., Cross, E., Angelini, K., Arnold, J., Revill, S., Locker, T., Capewell, S. J, Quinney, D., Campbell, S., Morris, F.
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328: 254-
[Abstract][Full Text]
Goldman, L., Kirtane, A. J.
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[Abstract][Full Text]
Ramnarayan, P., Kapoor, R. R, Coren, M., Nanduri, V., Tomlinson, A. L, Taylor, P. M, Wyatt, J. C, Britto, J. F
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[Abstract][Full Text]
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[Abstract][Full Text]
Liao, L., Mark, D. B.
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Goodacre, S, Calvert, N
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[Abstract][Full Text]
Udelson, J. E., Beshansky, J. R., Ballin, D. S., Feldman, J. A., Griffith, J. L., Heller, G. V., Hendel, R. C., Pope, J. H., Ruthazer, R., Spiegler, E. J., Woolard, R. H., Handler, J., Selker, H. P.
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288: 2693-2700
[Abstract][Full Text]
Bertrand, M. E., Simoons, M. L., Fox, K. A.A., Wallentin, L. C., Hamm, C. W., McFadden, E., De Feyter, P. J., Specchia, G., Ruzyllo, W.
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[Full Text]
McCullough, P. A., Nowak, R. M., Foreback, C., Tokarski, G., Tomlanovich, M. C., Khoury, N., Weaver, W. D., Sandberg, K. R., McCord, J.
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162: 2464-2468
[Abstract][Full Text]
Derhaschnig, U., Laggner, A. N., Roggla, M., Hirschl, M. M., Kapiotis, S., Marsik, C., Jilma, B.
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[Abstract][Full Text]
Erhardt, L., Herlitz, J., Bossaert, L., Halinen, M., Keltai, M., Koster, R., Marcassa, C., Quinn, T., van Weert, H.
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[Full Text]
Reilly, B. M., Evans, A. T., Schaider, J. J., Das, K., Calvin, J. E., Moran, L. A., Roberts, R. R., Martinez, E.
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[Abstract][Full Text]
Chuang, J.-H., Hripcsak, G., Heitjan, D. F.
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[Abstract][Full Text]
Goodacre, S W, Morris, F M, Campbell, S, Arnold, J, Angelini, K
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[Abstract][Full Text]
Kohn, M. A., Newman, T. B.
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[Abstract]
Miettinen, O. S.
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165: 1327-1328
[Full Text]
Calvin, J. E., Klein, L. W., VandenBerg, E. J., Meyer, P., Parrillo, J. E.
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36: 1803-1808
[Abstract][Full Text]
von Kodolitsch, Y., Schwartz, A. G., Nienaber, C. A.
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160: 2977-2982
[Abstract][Full Text]
Braunwald, E., Antman, E. M., Beasley, J. W., Califf, R. M., Cheitlin, M. D., Hochman, J. S., Jones, R. H., Kereiakes, D., Kupersmith, J., Levin, T. N., Pepine, C. J., Schaeffer, J. W., Smith, E. E. III, Steward, D. E., Theroux, P., Gibbons, R. J., Alpert, J. S., Eagle, K. A., Faxon, D. P., Fuster, V., Gardner, T. J., Gregoratos, G., Russell, R. O., Smith, S. C. Jr
(2000). ACC/AHA guidelines for the management of patients with unstable angina and non-st-segment elevation myocardial infarction: A report of the american college of cardiology/ american heart association task force on practice guidelines (committee on the management of patients with unstable angina). J Am Coll Cardiol
36: 970-1062
[Full Text]
Collinson, P O, Premachandram, S, Hashemi, K, Kennedy, R L.
(2000). Prospective audit of incidence of prognostically important myocardial damage in patients discharged from emergency department Commentary: Time for improved diagnosis and management of patients presenting with acute chest pain. BMJ
320: 1702-1705
[Abstract][Full Text]
Lee, T. H., Goldman, L.
(2000). Evaluation of the Patient with Acute Chest Pain. NEJM
342: 1187-1195
[Full Text]
Mehta, R. H., Eagle, K. A.
(2000). Missed Diagnoses of Acute Coronary Syndromes in the Emergency Room -- Continuing Challenges. NEJM
342: 1207-1210
[Full Text]
Griffith, J.
(2000). Artificial Neural Networks:: Are They Ready for Use as Clinical Decision Aids?. Med Decis Making
20: 243-244
Ewy, G. A., Ornato, J. P.
(2000). Emergency cardiac care: introduction. J Am Coll Cardiol
35: 825-880
[Full Text]
Geleijnse, M.L, Elhendy, A, Kasprzak, J.D, Rambaldi, R, Van Domburg, R.T, Cornel, J.H, Klootwijk, A.P.J, Fioretti, P.M, Roelandt, J.R.T.C, Simoons, M.L
(2000). Safety and prognostic value of early dobutamine-atropine stress echocardiography in patients with spontaneous chest pain and a non-diagnostic electrocardiogram. Eur Heart J
21: 397-406
[Abstract]
Hollander, J. E., Muttreja, M. R., Dalesandro, M. R., Shofer, F. S.
(1999). Risk stratification of emergency department patients with acute coronary syndromes using P-Selectin. J Am Coll Cardiol
34: 95-105
[Abstract][Full Text]
Lewis, W. R., Amsterdam, E. A., Turnipseed, S., Kirk, J. D.
(1999). Immediate exercise testing of low risk patients with known coronary artery disease presenting to the emergency department with chest pain. J Am Coll Cardiol
33: 1843-1847
[Abstract][Full Text]
Hunt, D. L., Haynes, R. B., Hanna, S. E., Smith, K.
(1998). Effects of Computer-Based Clinical Decision Support Systems on Physician Performance and Patient Outcomes: A Systematic Review. JAMA
280: 1339-1346
[Abstract][Full Text]
Panju, A. A., Hemmelgarn, B. R., Guyatt, G. H., Simel, D. L.
(1998). Is This Patient Having a Myocardial Infarction?. JAMA
280: 1256-1263
[Abstract][Full Text]
(1997). Attributes of ATS documents that guide clinical practice. Recommendations of the ATS Clinical Practice Committee. Am. J. Respir. Crit. Care Med.
156: 2015-2025
[Full Text]
Zalenski, R. J., McCarren, M., Roberts, R., Rydman, R. J., Jovanovic, B., Das, K., Mendez, J., El-Khadra, M., Fraker, L., McDermott, M.
(1997). An Evaluation of a Chest Pain Diagnostic Protocol to Exclude Acute Cardiac Ischemia in the Emergency Department. Arch Intern Med
157: 1085-1091
[Abstract]
Katz, D. A., Griffith, J. L., Beshansky, J. R., Selker, H. P.
(1996). The Use of Empiric Clinical Data in the Evaluation of Practice Guidelines for Unstable Angina. JAMA
276: 1568-1574
[Abstract]
Stubbs, P., Collinson, P., Moseley, D., Greenwood, T., Noble, M.
(1996). Prognostic Significance of Admission Troponin T Concentrations in Patients With Myocardial Infarction. Circulation
94: 1291-1297
[Abstract][Full Text]
Tosteson, A. N.A., Goldman, L., Udvarhelyi, I. S., Lee, T. H.
(1996). Cost-effectiveness of a Coronary Care Unit Versus an Intermediate Care Unit for Emergency Department Patients With Chest Pain. Circulation
94: 143-150
[Abstract][Full Text]
Goldman, L., Cook, E. F., Johnson, P. A., Brand, D. A., Rouan, G. W., Lee, T. H.
(1996). Prediction of the Need for Intensive Care in Patients Who Come to Emergency Departments with Acute Chest Pain. NEJM
334: 1498-1504
[Abstract][Full Text]
Balas, E. A., Austin, S. M., Mitchell, J. A., Ewigman, B. G., Bopp, K. D., Brown, G. D.
(1996). The Clinical Value of Computerized Information Services: A Review of 98 Randomized Clinical Trials. Arch Fam Med
5: 271-278
[Abstract]
Sgarbossa, E. B., Pinski, S. L., Barbagelata, A., Underwood, D. A., Gates, K. B., Topol, E. J., Califf, R. M., Wagner, G. S., The GUSTO-1 (Global Utilization of Streptokinase a, , Tissue Plasminogen Activator for Occluded Coronary,
(1996). Electrocardiographic Diagnosis of Evolving Acute Myocardial Infarction in the Presence of Left Bundle-Branch Block. NEJM
334: 481-487
[Abstract][Full Text]
Lewis, W. R., Amsterdam, E. A.
(1996). Evaluation of the Patient With 'Rule Out Myocardial Infarction'. Arch Intern Med
156: 41-45
[Abstract]
Kellett, J., Clarke, J.
(1995). Comparison of "Accelerated" Tissue Plasminogen Activator with Streptokinase for Treatment of Suspected Myocardial Infarction. Med Decis Making
15: 297-310
[Abstract]
Davis, D. A., Thomson, M. A., Oxman, A. D., Haynes, R. B.
(1995). Changing Physician Performance: A Systematic Review of the Effect of Continuing Medical Education Strategies. JAMA
274: 700-705
[Abstract]
Hollander, J. E., Hoffman, R. S., Burstein, J. L., Shih, R. D., Thode, H. C. Jr, Cocaine-Associated Myocardial Infarction Study Gro, , Bartfield, J., Raccio-Robak, N., Harchelroad, F., Hoffman, R. S., Shih, R. D., Nelson, L., Sandoval, M., Feldman, J., Fish, S., Carter, W., Paynter, R., Whelan, C., Silverman, R., Scheppke, K., Thomaser, H., Doyon, S., Wax, P., Lopez, B. L., Nelson, L., Shih, R. D., Imbesi, J., Giroski, L., Hollander, J. E., Burstein, J., Shepherd, S. M., Sparkes, M., Seger, D., Goetz, R. J., Morgan, D. L., Wilhelm, G., Schumb, D., Sporer, K. A., Sutton, B., Ling, L. J., Wilson, L., Hoekstra, J., Kulig, K., Phillips, S., Brent, J., Kulig, K., Phillips, S., Brent, J., Watson, W. A., Quick, A. M., Hollander, J. E., Hoffman, R. S., Thodejr, H. C., Hollander, J. E., Hoffman, R. S., Burstein, J., Shih, R. D., Thode, H. C. Jr
(1995). Cocaine-Associated Myocardial Infarction: Mortality and Complications. Arch Intern Med
155: 1081-1086
[Abstract]
Maynard, C., Selker, H. P., Beshansky, J. R., Griffith, J. L., Schmid, C. H., Califf, R. M., D'Agostino, R. B., Laks, M. M., Lee, K. L., Wagner, G. S., Weaver, W. D.
(1995). The Exclusion of Women from Clinical Trials of Thrombolytic Therapy: Implications for Developing the Thrombolytic Predictive Instrument Database. Med Decis Making
15: 38-43
[Abstract]
Pauker, S. G., Kopelman, R. I.
(1994). Invasive Interventions. NEJM
331: 601-605
[Full Text]
Baxt, W. G.
(1994). A Neural Network Trained to Identify the Presence of Myocardial Infarction Bases Some Decisions on Clinical Associations That Differ from Accepted Clinical Teaching. Med Decis Making
14: 217-222
[Abstract]
Midgette, A. S., Wong, J. B., Beshansky, J. R., Porath, A., Fleming, C., Pauker, S. G.
(1994). Cost - Effectiueness of Streptokinase for Acute Myocardial Infarction: A Combined Meta-analysis and Decision Analysis of the Effects of Infarct Location and of Likelihood of Infarction. Med Decis Making
14: 108-117
[Abstract]
Stiell, I. G., McKnight, R. D., Greenberg, G. H., McDowell, I., Nair, R. C., Wells, G. A., Johns, C., Worthington, J. R.
(1994). Implementation of the Ottawa Ankle Rules. JAMA
271: 827-832
[Abstract]
McDonald, C. J., Overhage, J. M.
(1994). Guidelines You Can Follow and Can Trust: An Ideal and an Example. JAMA
271: 872-873
[Abstract]
Jaeschke, R., Guyatt, G. H., Sackett, D. L., the Evidence-Based Medicine Working Group, , Guyatt, G., Bass, E., Brill-Edwards, P., Browman, G., Cook, D., Farkouh, M., Gerstein, H., Haynes, B., Hayward, R., Holbrook, A., Jaeschke, R., Juniper, E., Lee, H., Levine, M., Moyer, V., Nishikawa, J., Oxman, A., Patel, A., Philbrick, J., Richardson, W. S., Sauve, S., Sackett, D., Sinclair, J., Trout, K.S., Tugwell, P., Tunis, S., Walter, S., Wilson, M.
(1994). Users' Guides to the Medical Literature: III. How to Use an Article About a Diagnostic Test B. What Are the Results and Will They Help Me in Caring for My Patients?. JAMA
271: 703-707
[Abstract]
Baron, J. A.
(1994). Uncertainty in Bayes. Med Decis Making
14: 46-51
[Abstract]
Bergus, G.
(1993). Using Prediction Models to Reveal What We Need to Know. Arch Fam Med
2: 817-819
[Abstract]
Miller, M. E., Langefeld, C. D., Tierney, W. M., Hui, S. L., McDonald, C. J.
(1993). Validation of Probabilistic Predictions. Med Decis Making
13: 49-57
[Abstract]
Baxt, W. G.
(1991). Use of an Artificial Neural Network for the Diagnosis of Myocardial Infarction. ANN INTERN MED
115: 843-848
[Abstract]
Weingarten, S., Ermann, B., Bolus, R., Riedinger, M. S., Rubin, H., Green, A., Karns, K., Ellrodt, A. G.
(1990). Early "Step-Down" Transfer of Low-Risk Patients with Chest Pain: A Controlled Interventional Trial. ANN INTERN MED
113: 283-289
[Abstract]
Hickam, D. H.
(1990). Do Severity of Disease Classification Tools Chance Patient Care?. Med Decis Making
10: 153-154
Knaus, W. A., Rauss, A., Alperovitch, A., Le Gall, J.-R., Loirat, P., Patois, E., Marcus, S. E.
(1990). Do objectiue Estimates of chances for Survival Influence Decisions to Withhold or Withdraw Treatment?. Med Decis Making
10: 163-171
[Abstract]
Franklin, C., Rackow, E. C., Mamdani, B., Burke, G., Weil, M. H.
(1990). Triage Considerations in Medical Intensive Care. Arch Intern Med
150: 1455-1459
[Abstract]
sager, P. T., Bhandari, A. K.
(1989). Atrial Fibrillation: Another Perspective. J Intensive Care Med
4: 95-96
Silverstein, M. D.
(1988). Prediction Instruments and Clinical Judgment in Critical Care. JAMA
260: 1758-1759
[Abstract]
McNutt, R. A., Selker, H. P.
(1988). How Did the Acute Ischemic Heart Disease Predictiue Instrument Reduce Unnecessary Coronary Care Unit Admissions?. Med Decis Making
8: 90-94
[Abstract]
LEE, T. H., GOLDMAN, L.
(1988). The Coronary Care Unit Turns 25: Historical Trends and Future Directions. ANN INTERN MED
108: 887-894
[Abstract]
Quale, J., Kimmelstiel, C., Lipschik, G., Schrem, S.
(1988). Use of Sequential Cardiac Enzyme Analysis in Stratification of Risk for Myocardial Infarction in Patients With Unstable Angina. Arch Intern Med
148: 1277-1279
[Abstract]
Franklin, C. M., Rackow, E. C., Mamdani, B., Nightingale, S., Burke, G., Weil, M. H.
(1988). Decreases in Mortality on a Large Urban Medical Service by Facilitating Access to Critical Care: An Alternative to Rationing. Arch Intern Med
148: 1403-1405
[Abstract]
Tierney, W. M., McDonald, C. J., Hui, S. L., Martin, D. K.
(1988). Computer Predictions of Abnormal Test Results: Effects on Outpatient Testing. JAMA
259: 1194-1198
[Abstract]
Young, M. J., McMahon, L. F. Jr, Stross, J. K.
(1987). Prediction Rules for Patients With Suspected Myocardial Infarction: Applying Guidelines in Community Hospitals. Arch Intern Med
147: 1219-1222
[Abstract]
Simel, D. L., Feussner, J. R., Delong, E. R., Matchar, D. B.
(1987). Intermediate, Indeterminate, and Uninterpretable Diagnostic Test Results. Med Decis Making
7: 107-114
[Abstract]
Stark, C. M. E., Vacek, J. L.
(1987). The Initial Electrocardiogram During Admission for Myocardial Infarction: Use as a Predictor of Clinical Course and Facility Utilization. Arch Intern Med
147: 843-846
[Abstract]
Sax, F. L., Charlson, M. E.
(1987). Utilization of Critical Care Units: A Prospective Study of Physician Triage and Patient Outcome. Arch Intern Med
147: 929-934
[Abstract]
Selker, H. P., Griffith, J. L., Dorey, F. J., D'Agostino, R. B.
(1987). How Do Physicians Adapt When the Coronary Care Unit Is Full? A Prospective Multicenter Study. JAMA
257: 1181-1185
[Abstract]
LEE, T. H., ROUAN, G. W., WEISBERG, M. C., BRAND, D. A., COOK, E. F., ACAMPORA, D., GOLDMAN, L.
(1987). Sensitivity of Routine Clinical Criteria for Diagnosing Myocardial Infarction Within 24 Hours of Hospitalization. ANN INTERN MED
106: 181-186
[Abstract]
Neill, K. M.
(1987). A Review of Atypical Clinical Manifestations of Acute Myocardial Infarction. J Intensive Care Med
2: 25-32
[Abstract]
Dolan, J. G., Bordley, D. R., Mushlin, A. I.
(1986). An Eualuation of Clinicians' Subjective Prior Probability Estimates. Med Decis Making
6: 216-223
[Abstract]
LEE, T. H., GOLDMAN, L.
(1986). Serum Enzyme Assays in the Diagnosis of Acute Myocardial InfarctionRecommendations Based on a Quantitative Analysis. ANN INTERN MED
105: 221-233
[Abstract]
Bogden, P. E., Schatz, I. J.
(1985). Cost-effective Cardiology: The New Challenge. JAMA
253: 400-400
[Abstract]
Plotnick, G. D., Fisher, M. L.
(1985). Risk Stratification: A Cost-effective Approach to the Treatment of Patients With Chest Pain. Arch Intern Med
145: 41-42
[Abstract]
Lee, T. H., Cook, E. F., Weisberg, M., Sargent, R. K., Wilson, C., Goldman, L.
(1985). Acute Chest Pain in the Emergency Room: Identification and Examination of Low-Risk Patients. Arch Intern Med
145: 65-69
[Abstract]
