We have located links that may give you full text access.
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Triage of patients with chest pain in the emergency department: a comparative study of physicians' decisions.
American Journal of Medicine 2002 Februrary 2
PURPOSE: Little is known about physicians' triage decisions for patients with chest pain in the emergency department. We sought to understand better the variability and accuracy of physicians' triage decisions.
SUBJECTS AND METHODS: We used 20 simulated cases to compare triage decisions by 147 physicians (46 emergency medicine, 87 internal medicine, and 14 cardiology physicians) with triage decisions recommended by a previously validated prediction rule. We calculated triage sensitivity and specificity using the prediction rule to estimate the likelihood that each of the simulated patients would suffer a major complication. Triage sensitivity was defined as the proportion of all patients expected to have major complications who were triaged to the coronary care or inpatient telemetry unit.
RESULTS: Triage specificity was defined as the proportion of all patients without complications who were triaged to sites other than the coronary care or inpatient telemetry unit.Physicians' triage decisions were less sensitive (85% vs. 96%, P <0.001) and less specific (38% vs. 41%, P = 0.02) than decisions recommended by the prediction rule. Physicians overestimated patients' risk of complications and triaged more patients to inpatient monitored beds. Despite their preference for inpatient monitored beds, physicians' decisions would have resulted in four times as many major complications in patients who were not triaged to inpatient monitored beds, compared with decisions recommended by the prediction rule (2.4% vs. 0.6%, P <0.001). Although physicians' decisions were best explained by their provisional diagnoses, interphysician agreement about triage decisions (kappa = 0.34) and diagnosis (kappa = 0.31) was only fair.
CONCLUSIONS: In simulated cases, physicians' triage decisions varied widely and their predictions of patient outcomes differed markedly from that of the validated prediction rule, suggesting that use of the prediction rule in the emergency department could improve physicians' decisions and patients' outcomes.
SUBJECTS AND METHODS: We used 20 simulated cases to compare triage decisions by 147 physicians (46 emergency medicine, 87 internal medicine, and 14 cardiology physicians) with triage decisions recommended by a previously validated prediction rule. We calculated triage sensitivity and specificity using the prediction rule to estimate the likelihood that each of the simulated patients would suffer a major complication. Triage sensitivity was defined as the proportion of all patients expected to have major complications who were triaged to the coronary care or inpatient telemetry unit.
RESULTS: Triage specificity was defined as the proportion of all patients without complications who were triaged to sites other than the coronary care or inpatient telemetry unit.Physicians' triage decisions were less sensitive (85% vs. 96%, P <0.001) and less specific (38% vs. 41%, P = 0.02) than decisions recommended by the prediction rule. Physicians overestimated patients' risk of complications and triaged more patients to inpatient monitored beds. Despite their preference for inpatient monitored beds, physicians' decisions would have resulted in four times as many major complications in patients who were not triaged to inpatient monitored beds, compared with decisions recommended by the prediction rule (2.4% vs. 0.6%, P <0.001). Although physicians' decisions were best explained by their provisional diagnoses, interphysician agreement about triage decisions (kappa = 0.34) and diagnosis (kappa = 0.31) was only fair.
CONCLUSIONS: In simulated cases, physicians' triage decisions varied widely and their predictions of patient outcomes differed markedly from that of the validated prediction rule, suggesting that use of the prediction rule in the emergency department could improve physicians' decisions and patients' outcomes.
Full text links
Related Resources
Trending Papers
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
Molecular Targets of Novel Therapeutics for Diabetic Kidney Disease: A New Era of Nephroprotection.International Journal of Molecular Sciences 2024 April 4
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
A Guide to the Use of Vasopressors and Inotropes for Patients in Shock.Journal of Intensive Care Medicine 2024 April 14
Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association.Circulation 2024 April 19
Essential thrombocythaemia: A contemporary approach with new drugs on the horizon.British Journal of Haematology 2024 April 9
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app