title: Gender-specific uncertainties in the diagnosis of acute coronary syndrome.
abstract: BACKGROUND
  It is unknown whether higher rates of delayed diagnosis and misdiagnosis of acute coronary syndrome (ACS) in women might have contributed to the poorer outcome of women.
  
  
  METHODS
  In a prospective diagnostic multicenter study, we recruited patients presenting to the emergency department (ED) with any kind of chest discomfort/chest pain with onset or peak within the last 12 h. We quantified early diagnostic uncertainty for the presence of ACS among treating physicians at the ED after 90 min, possibly responsible for delayed diagnosis, using a visual analogue scale. Late diagnostic uncertainty, possibly responsible for misdiagnosis, was defined as disagreement among two independent cardiologists' adjudication of the final diagnosis after complete work-up.
  
  
  RESULTS
  Among 2795 patients (897 women and 1898 men), ACS was the adjudicated final diagnosis in 24 % of women and 35 % of men. Early diagnostic accuracy of clinical judgment of the ED physician for ACS as quantified by the area under the receiver-operating characteristics curve was 0.89 (95 % CI 0.87-0.92) in women and 0.86 (95 % CI 0.85-0.88) in men (p = 0.046). Late diagnostic uncertainty regarding the diagnosis of ACS was 5 % in women and 7 % in men (p = 0.069).
  
  
  CONCLUSIONS
  Diagnostic uncertainty for the presence of ACS in women is not more common as compared to men and does, therefore, not explain the poorer outcome observed in women with ACS.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov . Unique identifier: NCT00470587.
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.|Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Petra
authors.identifier: http://orcid.org/0000-0002-2285-6489
authors.initials: P
authors.lastname: Hillinger
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.|Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.|Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: Karin
authors.initials: K
authors.lastname: Wildi
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.|Emergency Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Rubini Gimenez
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.|Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Cedric
authors.initials: C
authors.lastname: Jaeger
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.|Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Jasper
authors.initials: J
authors.lastname: Boeddinghaus
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.|Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nestelberger
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.|Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Karin
authors.initials: K
authors.lastname: Grimm
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.|Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.|Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Fabio
authors.initials: F
authors.lastname: Stallone
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.|Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Puelacher
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.|Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Sabti
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.|Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Nikola
authors.initials: N
authors.lastname: Kozhuharov
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.|Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Ursina
authors.initials: U
authors.lastname: Honegger
authors.affiliation: Emergency Department, San Martino Hospital, Genoa, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Ballarino
authors.affiliation: Emergency Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Miro
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Kris
authors.initials: K
authors.lastname: Denhaerynck
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.|Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Temizel
authors.initials: T
authors.lastname: Ekrem
authors.affiliation: Medizinische Klinik, Kantonsspital, Olten, Switzerland.
authors.forename: Claudia
authors.initials: C
authors.lastname: Kohler
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.|Emergency Department, University Hospital, Basel, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Bingisser
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.|Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. Christian.Mueller@usb.ch.|Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. Christian.Mueller@usb.ch.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D000368:Aged; D019540:Area Under Curve; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D004636:Emergency Service, Hospital; D005060:Europe; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012737:Sex Factors; D035501:Uncertainty
keywords: Acute coronary syndrome; Delayed diagnosis; Diagnostic uncertainty; Gender