在一个多站点的美国队列研究中,HET (史,心电图和热素) 评分的有效性较低,预测值为负
Michael W Supples1, Alexa G Dameron1, Stephen Powell1
1Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
The American journal of emergency medicine
|December 27, 2024
概括
病史,心电图和热素 (HET) 评分不能安全地识别患有胸痛的低风险患者,因为它和HEART评分都没有达到99%的负预测值值. 此外,HET得分在风险分层方面也表现出较低的有效性.
科学领域:
- 心脏病学 心脏病学
- 紧急医疗 紧急医疗
- 临床风险分层的临床风险分层
背景情况:
- 病史,心电图和热素 (HET) 评分是一个简化的风险分层工具,用于急诊室的胸痛患者.
- 它是已建立的HEART得分的替代方案.
- 这项研究旨在评估HET得分的安全性和有效性,以预测30天的心脏死亡或心肌梗塞 (MI).
研究的目的:
- 评估HET得分在风险分层化急诊室患者胸痛的安全性和有效性.
- 为了比较HET得分的表现与30天心脏死亡或MI的HEART得分.
- 要确定HET得分是否达到负预测值 (NPV) ≥99%的安全值.
主要方法:
- 对STOP-CP多站点队列研究进行了二次分析.
- 患者被分为低风险,中风险和高风险组,使用HET和HEART分数.
- 计算了30天心脏病死亡或心肌梗塞的负预测值 (NPV),以及疗效 (低风险患者的比例).
主要成果:
- 无论是HET得分 (NPV 98.6%) 还是HEART得分 (NPV 97.8%),都没有达到30天心脏病死亡或心肌梗塞的安全门≥99%的NPV.
- 在HET得分中,有19.6%的患者被确定为低风险患者,与HEART得分 (36.6%) 相比,有效性明显较低.
- 30天心脏病死亡或心脏病发作发生率在低风险HET组为1.4%,在低风险HEART组为2.2%.
结论:
- 在这个美国队列中,无论是HET得分还是HEART得分都没有证明胸痛患者风险分层的安全性足够 (NPV ≥99%).
- 与HEART得分相比,HET得分在识别低风险患者方面的有效性明显较低.
- 需要进一步的研究来完善ED胸痛风险分层工具.
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