Document Detail

Pre-hospital triage of patients with suspected myocardial infarction. Evaluation of previously developed algorithms and new proposals.
MedLine Citation:
PMID:  7789374     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate previously developed algorithms for the improvement of pre-hospital triage of patients with suspected acute cardiac disease. DESIGN: Prospective study. SUBJECTS: Patients with symptoms of possible cardiac origin, who were seen by a general practitioner and subsequently referred to hospital in the municipality of Rotterdam. METHODS: Prior to hospital admission, patients with suspected acute coronary disease recorded their symptoms by standardized questionnaire and a computerized ECG was made. All patients were hospitalized and a final diagnosis was established. Algorithms proposed by other investigators to distinguish patients with, from those without, acute cardiac disease were tested. MAIN OUTCOME: Identification of patients whose likelihood for acute cardiac pathology was low (stable angina, atypical chest pain, other pathology) or high (myocardial infarction, unstable angina). RESULTS: A total of 1005 patients were studied. Forty-two percent had myocardial infarction or unstable angina pectoris. Evaluation of previously developed algorithms showed that their diagnostic accuracy was poor in the pre-hospital setting. In a separate multivariate analysis, six characteristics from the clinical history and an electrocardiogram appeared to be independently and significantly associated with acute cardiac pathology. The presence of an abnormal ECG proved to be the most important predictor. CONCLUSIONS: The hospital-based algorithms were unsuitable as a predictor for pre-hospital acute cardiac pathology. A new practical hospital admission model was developed, based on six clinical predictors, including analysis of an electrocardiogram. Following appropriate validation, this out-of-hospital protocol may lead to better triage decisions by the general practitioner.
E W Grijseels; J W Deckers; A W Hoes; J A Hartman; E Van der Does; E Van Loenen; M L Simoons
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European heart journal     Volume:  16     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  1995 Mar 
Date Detail:
Created Date:  1995-07-27     Completed Date:  1995-07-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  325-32     Citation Subset:  IM    
Thoraxcentre, Erasmus University Rotterdam, The Netherlands.
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MeSH Terms
Angina Pectoris / classification,  diagnosis*,  therapy
Angina, Unstable / classification,  diagnosis*,  therapy
Coronary Disease / classification,  diagnosis*,  therapy
Decision Support Techniques
Emergency Medical Services
Follow-Up Studies
Middle Aged
Myocardial Infarction / classification,  diagnosis*,  therapy
Patient Admission
Risk Factors
Treatment Outcome

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