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Development and validation of a prioritization rule for obtaining an immediate 12-lead electrocardiogram in the emergency department to identify ST-elevation myocardial infarction


Methodology:  3/5         
Usefulness:  3/5
Glickman SW, Shofer FS, Wu MC, Scholer MJ, Ndubuizu A, Peterson ED, Granger CB, Cairns CB, Glickman LT.
Am Heart J. 2012 Mar;163(3):372-82


This retrospective derivation of an ECG triage rule using classification and regression tree analysis of chief complaints from more than 3 million ED visits to 107 EDs in North Carolina found that prioritizing patients by various chief complaints at age cut-offs of 30, 50, and 80 years of age was 91.9% sensitive (NPV of 99.98%) for including patients who ultimately had a discharge diagnosis of STEMI. While this study was an adequate first step in derivation of this rule the group felt that major weaknesses were the lack of prospective validation and the potentially significant increase in the volume of ECGs that would need to be done at triage if this rule were implemented, thereby limiting its usefulness and practicality in real life. 
By: Dr. Abigail McGuire
(Presented January 2013)

Epi Lesson:
Large databases provide a wealth of data to help answer questions which may never be answered with an expensive RCT. A key step, however, in database research is evaluating the accuracy of data entry and reassuring the reader that the data are high quality. This can be done by hand verifying a random sample of entries or re-verifying diagnostic codes, for example.
By: Dr. Lisa Calder

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