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2002 ACC/AHA guideline versus clinician judgment as diagnostic tests for chest pain

Stephen M Hagberg1, Finbar Woitalla, Paul Crawford

  • 1Misawa Air Base, Japan.

Journal of the American Board of Family Medicine : JABFM
|March 18, 2008
PubMed

Insights

Clinical judgment and ACC/AHA guidelines effectively identify low-risk chest pain patients. This allows for safe emergency department discharge, reducing hospital admissions for chest pain and healthcare costs.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Clinical Diagnostics

Background:

  • Hospital admissions for chest pain are frequent, leading to significant healthcare expenditures.
  • Objective criteria for hospital admission may reduce costs associated with chest pain management.

Purpose of the Study:

  • To compare the 2002 ACC/AHA guidelines with clinical judgment in predicting positive cardiac troponin-I in chest pain patients.
  • To evaluate the diagnostic accuracy of these methods in identifying patients who require hospitalization.

Main Methods:

  • A retrospective chart review was conducted on patients admitted for chest pain over two years.
  • Sensitivity and specificity were calculated for ACC/AHA guidelines and clinical judgment in predicting elevated cardiac troponin-I.

Main Results:

  • Both ACC/AHA guidelines and clinical judgment demonstrated 100% sensitivity for predicting positive cardiac troponin-I.
  • Specificity was 13% for ACC/AHA guidelines and 48% for clinical judgment.
  • Low-risk classification by either method yielded a high negative predictive value (1.00).

Conclusions:

  • Patients classified as low risk using either ACC/AHA guidelines or clinical judgment can likely be safely discharged from the emergency department.
  • This approach may help reduce unnecessary hospitalizations for chest pain.
Abstract

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