Coronary care unit triage decision aids: how do we know when they work?

Decision aids for coronary care unit (CCU) triage of patients with suspected or known acute cardiac ischemia or myocardial infarction have attracted increasing attention from clinicians and the health care industry. In this issue, Weingarten and colleagues [1] at Cedars-Sinai Medical Center report their evaluation of two decision aids [2, 3] out of a growing number of such tools [2-9]

[1]  G O Barnett,et al.  The course of patients with suspected myocardial infarction. The identification of low-risk patients for early transfer from intensive care. , 1980, The New England journal of medicine.

[2]  R B D'Agostino,et al.  A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease. A prospective multicenter clinical trial. , 1984, The New England journal of medicine.

[3]  B. Psaty,et al.  Predictors of myocardial infarction in emergency room patients , 1985, Critical care medicine.

[4]  R. D'Agostino,et al.  How do physicians adapt when the coronary care unit is full? A prospective multicenter study. , 1987, JAMA.

[5]  R. Wears.  Prediction rules for patients with suspected myocardial infarction , 1988 .

[6]  A. Ellrodt,et al.  Selecting the best triage rule for patients hospitalized with chest pain. , 1989, The American journal of medicine.

[7]  Prediction rules for patients with suspected myocardial infarction. Applying guidelines in community hospitals. , 1987, Archives of internal medicine.

[8]  Electrocardiograms and decision aids in coronary care triage , 1987, Journal of general internal medicine.

[9]  L. Goldman,et al.  Care of patients with a low probability of acute myocardial infarction. Cost effectiveness of alternatives to coronary-care-unit admission. , 1984, The New England journal of medicine.

[10]  H P Selker,et al.  How Did the Acute Ischemic Heart Disease Predictiue Instrument Reduce Unnecessary Coronary Care Unit Admissions? , 1988, Medical decision making : an international journal of the Society for Medical Decision Making.

[11]  Michael W. Pozen,et al.  Optimal Identification of the Patient with Acute Myocardial Ischemia in the Emergency Room , 1985 .

[12]  R. Fuchs,et al.  Improved criteria for admission to cardiac care units. , 1981, JAMA.

[13]  Frans J. Th. Wackers,et al.  Use of the initial electrocardiogram to predict in-hospital complications of acute myocardial infarction. , 1985, The New England journal of medicine.

[14]  R B D'Agostino,et al.  The usefulness of a predictive instrument to reduce inappropriate admissions to the coronary care unit. , 1980, Annals of internal medicine.

[15]  E F Cook,et al.  A computer protocol to predict myocardial infarction in emergency department patients with chest pain. , 1988, The New England journal of medicine.

[16]  Jeffrey A. Stem,et al.  A computer-derived protocol to aid in the diagnosis of emergency room patients with acute chest pain. , 1982, The New England journal of medicine.