2002 ACC/AHA Guideline Versus Clinician Judgment as Diagnostic Tests for Chest Pain

• Published in: Journal of the American Board of Family Medicine Vol. 21; no. 2; pp. 101 - 107
• Main Authors: Hagberg, S. M., Woitalla, F., Crawford, P.
• Format: Journal Article
• Language: English
• Published: United States 01.03.2008
• Subjects: Adult; Aged; Angina, Unstable - blood; Angina, Unstable - diagnosis; Chest Pain - blood; Chest Pain - diagnosis; Chest Pain - etiology; Decision Making; Female; Guideline Adherence; Hospitalization; Humans; Male; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - diagnosis; Practice Guidelines as Topic; Practice Patterns, Physicians; Retrospective Studies; Risk Factors; Sensitivity and Specificity; Troponin I - blood
• ISSN: 1557-2625; 1558-7118
• DOI: 10.3122/jabfm.2008.02.070146

Hospital admissions for chest pain are frequent and costly. The use of objective criteria to determine the need for hospitalization may save money. Here we compare the 2002 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of patients with unstable angina and nonST-segment elevation myocardial infarction to clinical judgment as diagnostic tests to predict which patients with chest pain will develop positive cardiac troponin-I. Researchers conducted a retrospective chart review of patients admitted to a military community hospital for chest pain over a 2-year period. The study determined sensitivity and specificity for both the ACC/AHA guidelines and consensus of clinical judgment to predict which subjects would develop positive cardiac troponin-I. Positive cardiac troponin-I was very low (7 of 386). Both the ACC/AHA guidelines and clinical judgment had sensitivities of 100% (95% CI, 65-100) to predict positive cardiac troponin-I. The ACC/AHA guideline was 13% specific (95% CI, 12-13), with clinical judgment at 48% (95% CI, 47-48). Classification as low risk had a high negative predictive value (ACC/AHA guideline, 1.00 [95% CI, 0.95-1.00]; clinical judgment, 1.00 [95% CI, 0.99-1.00]). Patients categorized as low risk by either method could probably be discharged from the emergency department without developing positive troponin-I.