L A Green1, J F Yates. 1. Department of Family Practice, University of Michigan Medical School, Ann Arbor.
Abstract
STUDY OBJECTIVES: To measure the influence of classic epidemiologic risk factors (as recorded on the chart) on physicians' admission decisionmaking for patients with suspected acute cardiac ischemia and to compare the influence of those risk factors, which are of limited predictive utility, to the influence of predictively useful information. DESIGN: Retrospective chart review. SETTING: Emergency departments of two community hospitals. PARTICIPANTS: Seven hundred eighty-seven patients evaluated for suspected acute cardiac ischemia, whether admitted or not. RESULTS: Logistic regression revealed that the effect of a recorded history of hypertension on the admission decision (OR, 7.89; 95% CI, 4.57 to 13.58) was greater than that for ST-segment changes on the ECG (OR, 3.98; 95% CI, 2.56 to 6.18) or history of infarction (OR, 2.36; 95% CI, 1.53 to 3.62). A recorded history of diabetes had a small effect (OR, 1.84; 95% CI, 1.01 to 3.36), whereas Q waves and T-wave changes were not statistically significant. CONCLUSION: Physicians' admission decisions appeared to be more heavily influenced by pseudodiagnostic information than by information of objective predictive power. Physicians do not appear to distinguish risk factors from diagnostic information; education may be directed at this distinction.
STUDY OBJECTIVES: To measure the influence of classic epidemiologic risk factors (as recorded on the chart) on physicians' admission decisionmaking for patients with suspected acute cardiac ischemia and to compare the influence of those risk factors, which are of limited predictive utility, to the influence of predictively useful information. DESIGN: Retrospective chart review. SETTING: Emergency departments of two community hospitals. PARTICIPANTS: Seven hundred eighty-seven patients evaluated for suspected acute cardiac ischemia, whether admitted or not. RESULTS: Logistic regression revealed that the effect of a recorded history of hypertension on the admission decision (OR, 7.89; 95% CI, 4.57 to 13.58) was greater than that for ST-segment changes on the ECG (OR, 3.98; 95% CI, 2.56 to 6.18) or history of infarction (OR, 2.36; 95% CI, 1.53 to 3.62). A recorded history of diabetes had a small effect (OR, 1.84; 95% CI, 1.01 to 3.36), whereas Q waves and T-wave changes were not statistically significant. CONCLUSION: Physicians' admission decisions appeared to be more heavily influenced by pseudodiagnostic information than by information of objective predictive power. Physicians do not appear to distinguish risk factors from diagnostic information; education may be directed at this distinction.