PDF(Pubmed)
Abstract：
UNASSIGNED: Acute coronary syndrome (ACS) is a major cause of morbidity and mortality in the western world. Classic angina pectoris (AP) is a common reason to request prehospital emergency medical services (EMS). Nevertheless, data on diagnostic accuracy and common misdiagnoses are scarce. Therefore, the aim of this study is to evaluate the amount and variety of misdiagnoses and assess discriminating features.
UNASSIGNED: For this retrospective cohort study, all patients requiring EMS for suspected ACS in the city of Bonn (Germany) during 2018 were investigated. Prehospital and hospital medical records were reviewed regarding medical history, presenting signs and symptoms, as well as final diagnosis.
UNASSIGNED: Out of 740 analyzed patients with prehospital suspected ACS, 283 (38.2%) were ultimately diagnosed with ACS (ACS group). Common diagnoses in the cohort with non-confirmed ACS (nACS group) consisted of unspecific pain syndromes, arrhythmias, hypertensive crises, and heart failure. ST segment elevation (adjusted odds-ratios [adj. OR] 2.70), male sex (adj. OR 1.71), T wave changes (adj. OR 1.27), angina pectoris (adj. OR 1.15) as well as syncope (adj. OR 0.63) were identified among others as informative predictors in a multivariable analysis using the lasso technique for data-driven variable selection.
UNASSIGNED: Misdiagnosed ACS is as common as 61.8% in this cohort and analyses point to a complex of conditions and symptoms (i.e., male sex, electrocardiographic (ECG) changes, AP) for correct ACS diagnosis while neurological symptoms were observed significantly more often in the nACS group (e.g., Glasgow Coma Scale (GCS) < 15, p = 0.03). To ensure adequate and timely therapy for a potentially critical disease as ACS a profound prehospital examination and patient history is indispensable.
UNASSIGNED: For this retrospective cohort study, all patients requiring EMS for suspected ACS in the city of Bonn (Germany) during 2018 were investigated. Prehospital and hospital medical records were reviewed regarding medical history, presenting signs and symptoms, as well as final diagnosis.
UNASSIGNED: Out of 740 analyzed patients with prehospital suspected ACS, 283 (38.2%) were ultimately diagnosed with ACS (ACS group). Common diagnoses in the cohort with non-confirmed ACS (nACS group) consisted of unspecific pain syndromes, arrhythmias, hypertensive crises, and heart failure. ST segment elevation (adjusted odds-ratios [adj. OR] 2.70), male sex (adj. OR 1.71), T wave changes (adj. OR 1.27), angina pectoris (adj. OR 1.15) as well as syncope (adj. OR 0.63) were identified among others as informative predictors in a multivariable analysis using the lasso technique for data-driven variable selection.
UNASSIGNED: Misdiagnosed ACS is as common as 61.8% in this cohort and analyses point to a complex of conditions and symptoms (i.e., male sex, electrocardiographic (ECG) changes, AP) for correct ACS diagnosis while neurological symptoms were observed significantly more often in the nACS group (e.g., Glasgow Coma Scale (GCS) < 15, p = 0.03). To ensure adequate and timely therapy for a potentially critical disease as ACS a profound prehospital examination and patient history is indispensable.
摘要：
■急性冠状动脉综合征（ACS）是西方世界发病率和死亡率的主要原因。经典心绞痛（AP）是要求院前急诊医疗服务（EMS）的常见原因。然而，关于诊断准确性和常见误诊的数据很少。因此,这项研究的目的是评估误诊的数量和种类，并评估鉴别特征。
■对于这项回顾性队列研究，我们调查了2018年期间在波恩(德国)市因疑似ACS而需要EMS治疗的所有患者.根据病史审查院前和医院医疗记录，出现体征和症状，以及最终诊断。
■在740名被分析为院前疑似ACS的患者中，283例(38.2%)最终诊断为ACS(ACS组)。非确诊ACS（nACS组）队列中的常见诊断包括非特异性疼痛综合征，心律失常,高血压危机,和心力衰竭。ST段抬高（调整后的赔率比[调整。OR]2.70)，男性（adj.OR1.71)，T波变化（调整。OR1.27),心绞痛（adj.或1.15）以及晕厥（调整。OR0.63）在使用套索技术进行数据驱动变量选择的多变量分析中被确定为信息预测因子。
■在该队列中，误诊ACS的发生率为61.8％，分析指出了复杂的疾病和症状（即，男性,心电图（ECG）变化，AP）用于正确的ACS诊断，而在nACS组中观察到神经系统症状的频率明显更高（例如，格拉斯哥昏迷评分(GCS)<15,p=0.03)。为了确保作为ACS的潜在危重疾病的充分和及时的治疗，深刻的院前检查和患者病史是必不可少的。
■对于这项回顾性队列研究，我们调查了2018年期间在波恩(德国)市因疑似ACS而需要EMS治疗的所有患者.根据病史审查院前和医院医疗记录，出现体征和症状，以及最终诊断。
■在740名被分析为院前疑似ACS的患者中，283例(38.2%)最终诊断为ACS(ACS组)。非确诊ACS（nACS组）队列中的常见诊断包括非特异性疼痛综合征，心律失常,高血压危机,和心力衰竭。ST段抬高（调整后的赔率比[调整。OR]2.70)，男性（adj.OR1.71)，T波变化（调整。OR1.27),心绞痛（adj.或1.15）以及晕厥（调整。OR0.63）在使用套索技术进行数据驱动变量选择的多变量分析中被确定为信息预测因子。
■在该队列中，误诊ACS的发生率为61.8％，分析指出了复杂的疾病和症状（即，男性,心电图（ECG）变化，AP）用于正确的ACS诊断，而在nACS组中观察到神经系统症状的频率明显更高（例如，格拉斯哥昏迷评分(GCS)<15,p=0.03)。为了确保作为ACS的潜在危重疾病的充分和及时的治疗，深刻的院前检查和患者病史是必不可少的。
