Abstract：
Diagnostic error is not uncommon and diagnostic accuracy can be improved with the use of problem representation, pre-test probability, and Bayesian analysis for improved clinical reasoning.
A 48-year-old female presented as a transfer from another Emergency Department (ED) to our ED with crushing, substernal pain associated with dyspnea, diaphoresis, nausea, and a tingling sensation down both arms with radiation to the back and neck. Troponins were elevated along with an abnormal electrocardiogram. A negative myocardial perfusion scan led to the patient\'s discharge. The patient presented to the ED 10 days later with an anterior ST-elevation myocardial infarction.
An overemphasis on a single testing modality led to diagnostic error and a severe event. The use of pre-test probabilities guided by history-taking can lead to improved interpretation of test results, ultimately improving diagnostic accuracy and preventing serious medical errors.
A 48-year-old female presented as a transfer from another Emergency Department (ED) to our ED with crushing, substernal pain associated with dyspnea, diaphoresis, nausea, and a tingling sensation down both arms with radiation to the back and neck. Troponins were elevated along with an abnormal electrocardiogram. A negative myocardial perfusion scan led to the patient\'s discharge. The patient presented to the ED 10 days later with an anterior ST-elevation myocardial infarction.
An overemphasis on a single testing modality led to diagnostic error and a severe event. The use of pre-test probabilities guided by history-taking can lead to improved interpretation of test results, ultimately improving diagnostic accuracy and preventing serious medical errors.
摘要：
目的：诊断错误并不少见，使用问题表示可以提高诊断准确性，预测试概率，和贝叶斯分析，以改进临床推理。
方法：一名48岁的女性因挤压从另一个急诊科（ED）转移到我们的ED，与呼吸困难相关的胸骨后疼痛，排汗,恶心,双臂有刺痛感，背部和颈部有辐射。肌钙蛋白升高，心电图异常。阴性心肌灌注扫描导致患者出院。10天后，患者出现前部ST段抬高型心肌梗死。
结论：过分强调单一测试模式会导致诊断错误和严重事件。使用以历史记录为指导的测试前概率可以改善测试结果的解释，最终提高诊断准确性并防止严重的医疗错误。
方法：一名48岁的女性因挤压从另一个急诊科（ED）转移到我们的ED，与呼吸困难相关的胸骨后疼痛，排汗,恶心,双臂有刺痛感，背部和颈部有辐射。肌钙蛋白升高，心电图异常。阴性心肌灌注扫描导致患者出院。10天后，患者出现前部ST段抬高型心肌梗死。
结论：过分强调单一测试模式会导致诊断错误和严重事件。使用以历史记录为指导的测试前概率可以改善测试结果的解释，最终提高诊断准确性并防止严重的医疗错误。
