Prediction of the need for intensive care in patients who come to emergency departments with acute chest pain

New England Journal of Medicine

Volumn 334, Issue 23, 1996, Pages 1498-1504

  Goldman, Lee ^a   Cook, E Francis ^b,c   Johnson, Paula A ^b   Brand, Donald A ^d   Rouan, Gregory W ^e   Lee, Thomas H ^b  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b HARVARD MEDICAL SCHOOL   (United States)

^c HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

^d NEW YORK MEDICAL COLLEGE   (United States)

^e UNIVERSITY OF CINCINNATI MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACUTE HEART INFARCTION; ANGINA PECTORIS; ARTICLE; CONTROLLED STUDY; EMERGENCY HEALTH SERVICE; HEART ARRHYTHMIA; HUMAN; INTENSIVE CARE; MAJOR CLINICAL STUDY; MEDICAL DECISION MAKING; PATIENT CARE; PREDICTION; PRIORITY JOURNAL; RISK ASSESSMENT; RISK FACTOR;

ACUTE DISEASE; ADULT; CHEST PAIN; ELECTROCARDIOGRAPHY; EMERGENCY SERVICE, HOSPITAL; FEMALE; HUMANS; INTENSIVE CARE; MALE; MIDDLE AGED; MYOCARDIAL INFARCTION; MYOCARDIAL ISCHEMIA; RISK;

EID: 0029951005     PISSN: 00284793     EISSN: None     Source Type: Journal    
DOI: 10.1056/NEJM199606063342303     Document Type: Article

References (40)

1. Pozen MW, D'Agostino RB, Mitchell JB, et al. The usefulness of a predictive instrument to reduce inappropriate admissions to the coronary care unit. Ann Intern Med 1980;92:238-42.
2. Goldman L, Weinberg M, Weisberg M, et al. A computer-derived protocol to aid in the diagnosis of emergency room patients with acute chest pain. N Engl J Med 1982;307:588-96.
3. Pozen MW, D'Agostino RB, Selker HP, Sytkowski PA, Hood WB Jr. A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease: a prospective multicenter clinical trial. N Engl J Med 1984;310:1273-8.
4. Goldman L, Cook EF, Brand DA, et al. A computer protocol to predict myocardial infarction in emergency department patients with chest pain. N Engl J Med 1988;318:797-803.
5. Baxt WG. Use of an artificial neural network for the diagnosis of myocardial infarction. Ann Intern Med 1991;115:843-8. [Erratum, Ann Intern Med 1992;116:94.]
6. Baxt WG, Skora J. Prospective validation of artificial neural network trained to identify acute myocardial infarction. Lancet 1996;347:12-5.
7. Brush JE Jr, Brand DA, Acampora D, Chalmer B, Wackers FJ. Use of the initial electrocardiogram to predict in-hospital complications of acute myocardial infarction. N Engl J Med 1985;312:1137-41.
8. Stark ME, Vacek JL. The initial electrocardiogram during admission for myocardial infarction: use as a predictor of clinical course and facility utilization. Arch Intern Med 1987;147:843-6.
9. Yusuf S, Pearson M, Sterry H, et al. The entry ECG in the early diagnosis and prognostic stratification of patients with suspected acute myocardial infarction. Eur Heart J 1984;5:690-6.
10. Rude RE, Poole WK, Muller JE, et al. Electrocardiographic and clinical criteria for recognition of acute myocardial infarction based on analysis of 3,697 patients. Am J Cardiol 1983;52:936-42.
11. Mulley AG, Thibault GE, Hughes RA, Barnett GO, Reder VA, Sherman EL. The course of patients with suspected myocardial infarction: the identification of low-risk patients for early transfer from intensive care. N Engl J Med 1980;302:943-8.
12. Lee TH, Rouan GW, Weisberg MC, et al. Sensitivity of routine clinical criteria for diagnosing myocardial infarction within 24 hours of hospitalization. Ann Intern Med 1987;106:181-6.
13. Lee TH, Juarez G, Cook EF, et al. Ruling out acute myocardial infarction: a prospective multicenter validation of a 12-hour strategy for patients at low-risk. N Engl J Med 1991;324:1239-46.
14. Weingarten S, Ermann B, Bolus R, et al. Early "step-down" transfer of low-risk patients with chest pain: a controlled intervention trial. Ann Intern Med 1990;113:283-9.
15. Eagle KA, Mulley AG, Skates SJ, et al. Length of stay in the intensive care unit: effects of practice guidelines and feedback. JAMA 1990;264:992-7.
16. Mark DB, Sigmon K, Topol EJ, et al. Identification of acute myocardial infarction patients suitable for early hospital discharge after aggressive interventional therapy: results from the Thrombolysis and Angioplasty in Acute Myocardial Infarction Registry. Circulation 1991;83:1186-93.
17. Lee TH, Rouan GW, Weisberg MC, et al. Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room. Am J Cardiol 1987;60:219-24.
18. Fiebach NH, Cook EF, Lee TH, et al. Outcomes in patients with myocardial infarction who are initially admitted to stepdown units: data from the Multicenter Chest Pain Study. Am J Med 1990;89:15-20.
19. Kalbfleisch JD, Prentice RL. The statistical analysis of failure time data. New York: John Wiley, 1980.
20. Breiman L, Friedman JH, Olshen RA, Stone CJ. Classification and regression trees. Belmont, Calif.: Wadsworth International Group, 1984.
21. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959;22:719-48.
22. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982;143:29-36.
23. Hosmer DW Jr, Lemeshow S. Applied logistic regression. New York: John Wiley, 1989.
24. Killip T III, Kitmball JT. Treatment of myocardial infarction in a coronary care unit: a two year experience with 250 patients. Am J Cardiol 1967;20: 457-64.
25. Newby LK, Califf RM, Guerci A, et al. Early discharge in the thrombolytic era: an analysis of criteria for uncomplicated infarction from the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) Trial. J Am Coll Cardiol 1996;27:625-32.
26. Davison G, Suchman AL, Goldstein BJ. Reducing unnecessary coronary care unit admissions: a comparison of three decision aids. J Gen Intern Med 1990;5:474-9.
27. Sekler HP, Griffith JL, D'Agostino RB. A time-insensitive predictive instrument for acute myocardial infarction mortality: a multicenter study. Med Care 1991;29:1196-211.
28. Hamm CW, Ravkilde J, Gerhardt W, et al. The prognostic value of serum troponin T in unstable angina. N Engl J Med 1992;327:146-50.
29. Fineberg HV, Scadden D, Goldman L. Care of patients with a low probability of acute myocardial infarction: cost effectiveness of alternatives to coronary-care-unit admission. N Engl J Med 1984;310:1301-7.
30. Tosteson ANA, Goldman L, Udvarhelyi IS, Lee TH. Cost-effectiveness of a coronary care unit versus a stepdown unit for emergency department patients with acute chest pain. Circulation (in press).
31. Singer DE, Carr PL, Mulley AG, Thibault GE. Rationing intensive care - physician responses to a resource shortage. N Engl J Med 1983;309:1155-60.
32. Selker HP, Griffith JL, Dorey FJ, D'Agostino RB. How do physicians adapt when the coronary care unit is full? A prospective multicenter study. JAMA 1987;257:1181-5.
33. Gaspoz JM, Lee TH, Weinstein MC, et al. Cost-effectiveness of a new short-stay unit to "rule-out" acute myocardial infarction in low risk patients. J Am Coll Cardiol 1994;24:1249-59.
34. Weingarten SR, Riedinger MS, Conner L, et al. Practice guidelines and reminders to reduce duration of hospital stay for patients with chest pain: an interventional trial. Ann Intern Med 1994;120:257-63.
35. Lee TH, Pearson SD, Johnson PA, et al. Failure of information as an intervention to modify clinical management: a time-series trial in patients with acute chest pain. Ann Intern Med 1995;122:434-7.
36. Gibler WB, Young GP, Hedges JR, et al. Acute myocardial infarction in chest pain patients with nondiagnostic ECGs: serial CK-MB sampling in the emergency department: the Emergency Medicine Cardiac Research Group. Ann Emerg Med 1992;331:504-12.
37. Puleo PR, Meyer D, Wathen C, et al. Use of a rapid assay of subforms of creatine kinase MB to diagnose or rule out acute myocardial infarction. N Engl J Med 1994;331:561-6.
38. Ravkilde J, Nissen H, Horder M, Thygesen K. Independent prognostic value of serum creatine kinase isoenzyme MB mass, cardiac troponin T and myosin light chain levels in suspected acute myocardial infarction: analysis of 28 months of follow-up in 196 patients. J Am Coll Cardiol 1995;25:574-81.
39. Hilton TC, Thompson RC, Williams HJ, Saylors R, Folmer H, Stowers SA. Technetium-99m sestamibi myocardial perfusion imaging in the emergency room evaluation of chest pain. J Am Coll Cardiol 1994;23:1016-22.
40. Berning J, Launbjerg J, Appleyard M. Echocardiographic algorithms for admission and predischarge prediction of mortality in acute myocardial infarction. Am J Cardiol 1992;69:1538-44.