| Validation of a triage flowchart to rule out acute coronary syndrome. | |
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MedLine Citation:
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PMID: 20961935 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Objective To validate a triage flowchart to rule out acute coronary syndrome (ACS) in chest pain patients attending the emergency department (ED). Methods An observational cohort study of consecutive patients. In all cases, a previously derived five-step triage flowchart (age ≤40 years, absence of diabetes, not previously known coronary artery disease, non-oppressive and non-retrosternal pain) was applied. Patients meeting all five discriminators were grouped as 'five-step triage non-ACS', the rest as 'five-step triage ACS'. The same strategy was used with a four-step model (without age ≤40 years). After ED study and 1-month follow-up, patients were definitively classified as 'true ACS' or 'true non-ACS'. Validity indexes and receiver operating characteristics curves were calculated. Results 4231 patients were included: 918 (21.7%) were 'true ACS', 3303 (78.1%) 'true non-ACS'; 10 (0.2%) were lost to follow-up. The five-step triage flowchart classified 4000 (94.8%) as 'triage ACS' and 221 (5.2%) as 'triage non-ACS'; none of the latter was 'true ACS'. The four-step model classified 3194 (75.6%) as 'triage ACS' and 1027 (24.4%) as 'triage non-ACS'. A 'true ACS' was seen in 26 patients from the latter group. Accordingly, five-step triage flowchart specificity and positive predictive value (PPV) to rule out ACS were 100% (95% CI 100% to 100%). For the four-step model specificity and PPV were 97% (95% CI 96% to 98%). Conclusion The five-step triage flowchart identifies chest pain patients without an ACS. However, only 5% of these patients meet these five criteria. A simpler model allows greater patient inclusion but a higher risk of misclassification of true ACS. |
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Authors:
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Beatriz López; Miquel Sánchez; Ernest Bragulat; Sònia Jiménez; Blanca Coll-Vinent; Mar Ortega; Elisenda Gómez-Angelats; Oscar Miró |
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Publication Detail:
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Type: Journal Article Date: 2010-10-20 |
Journal Detail:
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Title: Emergency medicine journal : EMJ Volume: 28 ISSN: 1472-0213 ISO Abbreviation: Emerg Med J Publication Date: 2011 Oct |
Date Detail:
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Created Date: 2011-09-15 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100963089 Medline TA: Emerg Med J Country: England |
Other Details:
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Languages: eng Pagination: 841-6 Citation Subset: IM |
Affiliation:
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Emergency Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Catalonia, Spain; msanchez@clinic.ub.es. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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