Diagnostic Value of Clinical Suspicion of Residents ‎and Emergency Physicians for Acute ‎Myocardial ‎Infarction

Diagnostic Value of Clinical Suspicion of Residents ‎and Emergency Physicians for Acute ‎Myocardial ‎Infarction

Authors

  • Ayoub Tavakolian Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Elahe Etemadi Mashhadi Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, ‎Mashhad, Iran.
  • Mohsen Ebrahimi Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, ‎Mashhad, Iran
  • Roohie Farzaneh Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, ‎Mashhad, Iran
  • Majid Jalal Yazdi Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, ‎Iran.‎

Keywords:

Clinical suspicion, Residents, Emergency physician, Acute myocardial infarction ‎, Chest pain

Abstract

Objective: To evaluate clinical suspicion in residents and emergency medicine specialists in Edalatian ‎emergency department (ED) patients with suspected cardiac chest pain, in the diagnosis of acute ‎myocardial infarction

Methods: This was a cross-sectional study on patients with suspected acute myocardial infarction ‎‎(AMI) who were visited by emergency medicine specialists, first- and third-year residents. Each of ‎the doctors completed a form of clinical suspicion of myocardial infarction after clinical suspicion, after ‎electrocardiography (ECG), and first troponin test. Golden diagnostic criteria were serial ECG and ‎troponin levels till 6 hours, incorporated by a cardiologist. ‎

Result: Total of 430 patients were studied, of which 68 patients (15.8%) were diagnosed with AMI. ‎Diagnosis of the first-year resident, third-year resident, and emergency specialist based on clinical ‎suspicion had sensitivity of 72.06%(95%CI:59.9 to 82.3), 97.06%(95%CI:89.8 to 99.6), ‎‎94.12%(95%CI:85.6 to 98.4) and specificity of 32.60%(95%CI:27.8 to 37.7), 61.88%(95%CI:56.7 to ‎‎66.9), 55.80%(50.5 to 61.0), respectively. Adding the ECG findings, sensitivity increased or remained ‎unchanged and specificity decreased in all three groups. After including troponin results for diagnosis, ‎sensitivity increased in all groups but specificity decreased in first-year residents and increased in third-year residents, and emergency physicians. ‎

Conclusion: The use of clinical suspicion for ruling out myocardial infarction is a tool with average ‎power. The accuracy of diagnosis varied among different levels of experience of physicians, with third-year residents having the highest sensitivity and emergency physicians having the highest specificity. ‎These findings highlight the importance of considering multiple factors in diagnosis of myocardial ‎infarction and the value of experience in medical decision-making.

Declarations: 

Funding:

Mashhad University of Medical Sciences‎.

Conflicts of interest:

None.

Authors' contributions: 

AT,: Conceptualization and methodology; Writing - original draft preparation; Writing - review and editing

ME: Conceptualization and methodology; Data curation and analysis; Conceptualization and methodology

EEM: Writing - original draft preparation; Conceptualization and methodology; Writing - review and editing

RF: Writing - original draft preparation; Conceptualization and methodology; Writing - review and editing

MJY: Writing - original draft preparation; Data curation and analysis; Conceptualization and methodology

 

Acknowledgments ‎

None.

Ethical considerations

The study was approved by the Institutional Review Board of Mashhad University of Medical Sciences (IRB code: IR.MUMS.Fm.REC.1394.586).

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Published

2023-02-25

How to Cite

Tavakolian, A., Etemadi Mashhadi, E., Ebrahimi, M., Farzaneh, R., & Jalal Yazdi, M. (2023). Diagnostic Value of Clinical Suspicion of Residents ‎and Emergency Physicians for Acute ‎Myocardial ‎Infarction. Updates in Emergency Medicine, 3(1). Retrieved from http://uiemjournal.com/index.php/main/article/view/31

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Research Study

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