The DOI matches its Crossref record; 12 of the 12 references it cites were found in a registry or an index.
A Computer-Derived Protocol to Aid in the Diagnosis of Emergency Room Patients with Acute Chest Pain
Abstract
To determine whether data available to physicians in the emergency room can accurately identify which patients with acute chest pain are having myocardial infarctions, we analyzed 482 patients at one hospital. Using recursive partitioning analysis, we constructed a decision protocol in the format of a simple flow chart to identify infarction on the basis of nine clinical factors. In prospective testing on 468 other patients at a second hospital, the protocol performed as well as the physicians. Moreover, an integration of the protocol with the physicians' judgments resulted in a classification system that preserved sensitivity for detecting infarctions, significantly improved the specificity (from 67 per cent to 77 per cent, P less than 0.01) and positive predictive value (from 34 per cent to 42 per cent, P = 0.016) of admission to an intensive-care area. The protocol identified a subgroup of 107 patients among whom only 5 per cent had infarctions and for whom admission to non-intensive-care areas might be appropriate. This decision protocol warrants further wide-scale prospective testing but is not ready for routine clinical use.
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Cites
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Self-citationAn Analysis of Variance for Categorical Data
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Cited by
Braunwald, E., Antman, E. M., Beasley, J. W., Califf, R. M., Cheitlin, M. D., Hochman, J. S., Jones, R. H., Kereiakes, D., Kupersmith, J., Levin, T. N., et al. (2000) · Circulation · doi:10.1161/01.cir.102.10.1193 · Cited by 4,487
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Rosen, R., Cappelleri, J., Smith, M., Lipsky, J., & Peña, B. (1999) · International Journal of Impotence Research · doi:10.1038/sj.ijir.3900472 · Cited by 3,053
Clinical versus mechanical prediction: a meta-analysis
Grove, W. M., Zald, D. H., Lebow, B. S., Snitz, B. E., & Nelson, C. (2000) · Psychological Assessment · doi:10.1037/1040-3590.12.1.19 · Cited by 1,640
Clinical Prediction Rules: Applications and Methodological Standards
Wasson, J. H., Sox, H. C., Neff, R. K., & Goldman, L. (1985) · New England Journal of Medicine · doi:10.1056/nejm198509263131306 · Cited by 1,357
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Metadata
- Authors
- Goldman, L., Weinberg, M., Weisberg, M., Olshen, R., Cook, E. F., Sargent, R. K., Lamas, G. A., Dennis, C., Wilson, C., Deckelbaum, L., Fineberg, H., Stiratelli, R., & Hospital*, T. M. H. S. A. Y. H. H. A. B. A. W.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1982-09-02
- Volume
- 307
- Issue
- 10
- Pages
- 588-596
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2078322828
- Cited by
- 502
- References
- 12
- FWCI
- 87.68
- Type
- journal article
- Language
- en
- Open access
- closed
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- Goldman, L., Weinberg, M., Weisberg, M., Olshen, R., Cook, E. F., Sargent, R. K., Lamas, G. A., Dennis, C., Wilson, C., Deckelbaum, L., Fineberg, H., Stiratelli, R., & Hospital*, T. M. H. S. A. Y. H. H. A. B. A. W. (1982). A Computer-Derived Protocol to Aid in the Diagnosis of Emergency Room Patients with Acute Chest Pain. New England Journal of Medicine. https://doi.org/10.1056/nejm198209023071004
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