Applying the acute ischemic heart disease predictive instrument.
A predictive instrument (or index) previously reported to be of value in reducing unnecessary coronary care unit admissions was tested in a randomized study. Acceptability to the physician was then measured by monitoring utilization in a subsequent nonrandomized phase and by debriefing. The predictive instrument retained predictive accuracy in the new setting with good correlation between predicted and actual risk of acute cardiac ischemia (r = 0.925). False-positive diagnosis rate decreased from 71 percent to 0.0 percent (P = .0096) in a subgroup admitted to the intermediate care unit, consistent with previously reported usefulness in low-risk patients. Acceptability was poor, however, with utilization rate of only 2.8 percent of eligible patients. Debriefing revealed low perceived usefulness. This problem will need to be addressed if widespread utilization is to occur. The criteria of predictive accuracy, usefulness, and acceptability are suggested as a standard panel for testing new predictive instruments.
D000328:Adult; D001291:Attitude of Health Personnel; D003325:Coronary Care Units; D003327:Coronary Disease / Q000175:diagnosis* / Q000628:therapy; D004562:Electrocardiography; D004630:Emergencies; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011336:Probability; D011897:Random Allocation