Predictors of myocardial infarction in emergency room patients

W. M. Tierney, B. J. Roth, B. Psaty, R. McHenry, J. Fitzgerald, D. L. Stump, F. K. Anderson, K. W. Ryder, C. J. McDonald, D. M. Smith

Research output: Contribution to journalArticle

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Abstract

To develop a decision rule to aid in the diagnosis of myocardial infarction, we evaluated clinical and ECG data on 540 adults treated in an urban hospital emergency room for acute chest pain. Of 62 (11.5%) patients who had acute infarctions, 54 were admitted to intensive care (sensitivity 87%); 103 of 478 patients without infarctions were also admitted to intensive care (specificity 78%). Thirty-four percent of all patients admitted had infarctions. Multivariate analysis identified only four clinical variables which carried independent information predicting infarction: two from the ECG and two from the clinical history. A predictive model based on these four variables had significantly greater specificity (86% vs. 78%, p = .003) and accuracy of overall patient classification (88% vs. 79%, p = 0.13) but somewhat lower sensitivity (81% vs. 87%, p = .46) than physician judgments. However, a decision rule which would have admitted to intensive care those patients with a high probability of infarction who were not admitted by the emergency room physicians, would have increased the sensitivity for detecting infarction to 95% with no appreciable decrease in specificity or yield of infarctions among patients admitted to intensive care.

Original languageEnglish
Pages (from-to)526-531
Number of pages6
JournalCritical Care Medicine
Volume13
Issue number7
StatePublished - 1985

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Infarction
Hospital Emergency Service
Myocardial Infarction
Critical Care
Electrocardiography
Physicians
Urban Hospitals
Acute Pain
Chest Pain
Multivariate Analysis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Tierney, W. M., Roth, B. J., Psaty, B., McHenry, R., Fitzgerald, J., Stump, D. L., ... Smith, D. M. (1985). Predictors of myocardial infarction in emergency room patients. Critical Care Medicine, 13(7), 526-531.

Predictors of myocardial infarction in emergency room patients. / Tierney, W. M.; Roth, B. J.; Psaty, B.; McHenry, R.; Fitzgerald, J.; Stump, D. L.; Anderson, F. K.; Ryder, K. W.; McDonald, C. J.; Smith, D. M.

In: Critical Care Medicine, Vol. 13, No. 7, 1985, p. 526-531.

Research output: Contribution to journalArticle

Tierney, WM, Roth, BJ, Psaty, B, McHenry, R, Fitzgerald, J, Stump, DL, Anderson, FK, Ryder, KW, McDonald, CJ & Smith, DM 1985, 'Predictors of myocardial infarction in emergency room patients', Critical Care Medicine, vol. 13, no. 7, pp. 526-531.
Tierney WM, Roth BJ, Psaty B, McHenry R, Fitzgerald J, Stump DL et al. Predictors of myocardial infarction in emergency room patients. Critical Care Medicine. 1985;13(7):526-531.
Tierney, W. M. ; Roth, B. J. ; Psaty, B. ; McHenry, R. ; Fitzgerald, J. ; Stump, D. L. ; Anderson, F. K. ; Ryder, K. W. ; McDonald, C. J. ; Smith, D. M. / Predictors of myocardial infarction in emergency room patients. In: Critical Care Medicine. 1985 ; Vol. 13, No. 7. pp. 526-531.
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