Diagnostic Value of Clinical Suspicion of Residents and Emergency Physicians for Acute Myocardial Infarction
Keywords:
Clinical suspicion, Residents, Emergency physician, Acute myocardial infarction , Chest painAbstract
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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