title: Body surface mapping versus the standard 12 lead ECG in the detection of myocardial infarction amongst emergency department patients: a Bayesian approach.
abstract: OBJECTIVE
  To determine if body surface mapping (BSM) is better than the standard 12 lead ECG in the diagnosis of acute myocardial infarction amongst emergency department patients.
  
  
  METHODS
  A University affiliated inner-city emergency department.
  
  
  METHODS
  People presenting to an emergency department with symptoms compatible with myocardial ischaemia/infarction.
  
  
  METHODS
  Myocardial infarction as defined by either standard 12 lead ECG changes with associated cardiac marker rise, Troponin T >0.1 microg/ml at > 12 h or autopsy/surgical findings of fresh macroscopic infarction.
  
  
  RESULTS
  BSM had an overall sensitivity of 47.1% versus 40% for the 12 lead ECG (P < 0.001). Specificity for the BSM was 85.6% versus 93.7% for the 12 lead ECG (P < 0.001). These findings were consistent for low/moderate and high risk subgroups. Bayesian analysis demonstrates that indiscriminate use of BSM would result in a clinically important overdiagnosis of myocardial infarction amongst emergency department patients.
  
  
  CONCLUSIONS
  BSM has a higher sensitivity, but a lower specificity for the diagnosis of myocardial infarction.
authors.affiliation: simon.carley@cmmc.nhs.uk
authors.forename: Simon D
authors.initials: SD
authors.lastname: Carley
authors.forename: Michelle
authors.initials: M
authors.lastname: Jenkins
authors.forename: Kevin
authors.initials: K
authors.lastname: Mackway Jones
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D018780:Body Surface Potential Mapping; D002637:Chest Pain / Q000209:etiology; D004562:Electrocardiography / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D006113:United Kingdom