IMPACT OF THE ACUTE CARDIAC ISCHEMIA TIME-INSENSITIVE PREDICTIVE INSTRUMENT (ACI-TIPI) ON THE SPEED OF TRIAGE DECISION-MAKING FOR EMERGENCY DEPARTMENT PATIENTS PRESENTING WITH CHEST PAIN - A CONTROLLED CLINICAL-TRIAL

被引：30

作者：

SARASIN, FP ^{[1
]}

REYMOND, JM ^{[1
]}

GRIFFITH, JL ^{[1
]}

BESHANSKY, JR ^{[1
]}

SCHIFFERLI, JA ^{[1
]}

UNGER, PF ^{[1
]}

SCHERRER, JR ^{[1
]}

SELKER, HP ^{[1
]}

机构：

[1] TUFTS UNIV,NEW ENGLAND MED CTR 1031,SCH MED,CTR CARDIOVASC HLTH SERV RES,BOSTON,MA 02111

来源：

JOURNAL OF GENERAL INTERNAL MEDICINE | 1994年 / 9卷 / 04期

关键词：

ACUTE CARDIAC ISCHEMIA; COMPUTERIZED ELECTROCARDIOGRAPH; EMERGENCY DEPARTMENT; MEDICAL DECISION MAKING; PHYSICIAN TRAINING; TIME-INSENSITIVE PREDICTIVE INSTRUMENT;

D O I：

10.1007/BF02600122

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Objective: Emergency department (ED) triage for acute cardiac ischemia in the primary teaching hospital in Geneva, Switzerland, is very accurate, but at the cost of very long ED stays. Thus, the authors sought: 1) to determine the impact of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI), incorporated into a computerized electrocardiograph, on length of stay and speed of triage decision making for ED patients presenting with symptoms suggesting acute cardiac ischemia, and 2) to study the ACI-TIPI's impact on physicians of different training levels. Design: A seven-month prospective clinical trial with alternating-month experimental and control periods. Setting: An urban major teaching hospital in Geneva, Switzerland. Participants: Patients over the age of 18 years presenting to the ED with chest pain or other symptoms suggesting acute cardiac ischemia (acute myocardial infarction or unstable angina pectoris). Emergency department physicians, classified as novice (those in their first ED rotations) and experienced (those in their second or later ED rotations). Patients staying overnight in die ED (n = 111) were excluded from the analysis. Intervention: During the experimental months, the computerized electrocardiograph printed the ACI-TIPI probability of acute cardiac ischemia at the top of each subject's electrocardiogram. During control months, the probability was not provided. Measurements and main results: Among the 418 study subjects, for patients with acute ischemia seen by novice clinicians, the use of the ACI-TIPI decreased ED time from presentation to triage decision and ED release by 0.7 hour (19%) (p = 0.007). Subgroup analyses for patients with acute myocardial infarction, patients with unstable angina pectoris, and patients given thrombolytic therapy also showed analogous decreases in ED time consistent with this finding. Other key determinants of ED length of stay included: age, whether the coronary care unit was full, whether patients received thrombolytic therapy, and whether admission was during the night shift. The experimental and control groups did not differ in triage disposition appropriateness or mortality. Conclusions: For ED patients with acute cardiac ischemia evaluated by novice clinicians, the ACI-TIPI substantially speeded ED decision making and triage. The suggestion of an impact on different cardiac ischemia subgroups and mortality deserves further larger clinical trials.

引用

页码：187 / 194

页数：8

共 16 条

[1]

Long-term effects of intravenous thrombolysis in acute myocardial infarction: final report of the GISSI study, Lancet, 2, pp. 871-4, (1987)

[2]

Doorey A.J., Michelson E.L., Topol E.J., Thrombolytic therapy of acute myocardial infarction: keeping the unfulfilled promise, JAMA, 268, pp. 3108-14, (1992)

[3]

Pozen M.W., D'Agostino R.B., Mitchell J.B., Et al., The usefulness of a predictive instrument to reduce inappropriate admissions to the coronary care unit, Ann Intern Med, 92, pp. 238-42, (1980)

[4]

Tierney W.M., Roth B.J., Psaty B., Et al., Predictors of myocardial infarction in emergency room patients, JAMA, 246, pp. 2037-41, (1981)

[5]

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, 307, pp. 588-96, (1982)

[6]

Pozen M.W., D'Agostino R.B., Selker H.P., Et al., A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease: a prospective multicenter clinical trial, N EnglJ Med, 310, pp. 1273-8, (1984)

[7]

Selker H.P., Griffith J.L., D'Agostino R.B., A tool for judging coronary care unit admission appropriateness valid for both real-time and retrospective use: a time-insensitive predictive instrument (TIPI) for acute cardiac ischemia: a multicenter study, Med Care, 29, pp. 610-27, (1991)

[8]

Selker H.P., D'Agostino R.B., Laks M.M., A predictive instrument for acute ischemic heart disease to improve coronary care unit admission practices: a potential on-line tool in a computerized electrocardiograph, Journal of Electrocardiology, 21, (1988)

[9]

Cairns C.B., Niemann J.T., Selker H.P., Laks M.M., A computerized version of the time-insensitive predictive instrument: use of the Q wave, ST segment, T wave and patient history in the diagnosis of acute myocardial infarction by the computerized ECG, J Electrocardiol, 24, pp. S46-S49, (1992)

[10]

Selker H.P., Griffith J.L., Dorey F.J., D'Agostino R.B., How do physicians adapt when the coronary care unit is full? A prospective multi-center clinical study, JAMA, 257, pp. 1181-5, (1987)

← 1 2 →