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Criteria‐based Expert System for Cardiac Ischemia Evaluation in the Emergency Department
Author(s) -
Hirshberg Alan J.
Publication year - 1996
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.1996.tb03492.x
Subject(s) - medicine , mcnemar's test , chest pain , emergency department , myocardial infarction , cardiac catheterization , angina , unstable angina , emergency medicine , ischemia , acute coronary syndrome , cardiology , physical therapy , statistics , mathematics , psychiatry
ABSTRACT Objective : To develop and evaluate a cardiac ischemia computer expert system using a criteria‐based expert shell for assessment of chest pain patients in a community hospital ED setting. Methods : A retrospective, comparison study of the expert system against the clinical judgment of board‐certified emergency physicians (EPs) was performed in 1 community hospital ED. All chest pain patients had either a cardiac catheterization, Persantine stress testing, or both within 1 month of ED presentation. A final diagnosis of acute myocardial infarction or unstable angina by a consultant cardiologist represented the criterion standard for cardiac ischemia. Results : Of the 59 patients meeting study criteria, 28 (47%) had cardiac ischemia. The expert system had equal sensitivity (100%) and was more than twice as specific (39% vs 16%) in diagnosing ischemic cardiac disease as were the board‐certified EPs (p < 0.001; McNemar's chi‐square with Yates' correction). Conclusions : The criteria‐based system built around a system of findings ordered by Bayes' rule has potential to augment the ability of the EP to accurately diagnose ischemic heart disease.