title: Criteria-based expert system for cardiac ischemia evaluation in the emergency department.
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.
authors.affiliation: Center for Emergency Medical Services, Penn State University, College of Medicine, Milton S. Hershey Medical Center, Hershey, PA 17033-0850, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Hirshberg
authors.forename: T G
authors.initials: TG
authors.lastname: Guttman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003657:Decision Making; D003936:Diagnosis, Computer-Assisted; D004636:Emergency Service, Hospital; D005069:Evaluation Studies as Topic; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D010819:Physician's Role; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity