Decision aids for triage of patients with chest pain: a systematic review of field evaluation studies

• Published in: Proceedings - AMIA Symposium pp. 231 - 235
• Main Authors: Colombet, I, Chatellier, G, Jaulent, M C, Degoulet, P
• Format: Journal Article
• Language: English
• Published: United States American Medical Informatics Association 1999
• Subjects: Chest Pain - diagnosis; Controlled Clinical Trials as Topic; Decision Support Techniques; Emergency Service, Hospital; Evaluation Studies as Topic; Humans; Myocardial Ischemia - diagnosis; Sensitivity and Specificity; Triage
• ISSN: 1531-605X

We performed an overview of published controlled trials to assess the overall effectiveness of decision aids directed at improving triage of patients with acute chest pain. Searches of the Medline database identified 11 randomized or quasi-randomized controlled trials testing various decision aids: risk stratification system (n = 6), practice guidelines (n = 3), and formalized protocols of care (n = 2). Sensitivity, specificity of the decision aid and length of stay (LOS) in the intensive care unit (ICU) were the main outcomes. Decision aids slightly modified sensitivity and specificity (available in 5 studies), but sensitivity was already high in reference groups. Among the 9 studies providing information on LOS, 7 showed a statistically significant difference favoring the decision aid. The level of evidence concerning the efficacy of decision aids in this domain is relatively low. Larger and appropriately designed clinical trials are required to show an impact on acute cardiac ischaemia complications and mortality.