A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study
Journal Club Summary
Methodology Score: 4/5
Usefulness Score: 3/5
Than M, Cullen L, Reid CM, Lim SH, Aldous S, Ardagh MW, et al.
Lancet. 2011 Mar 26;377(9771):1077-84.
This prospective multicentre cohort study attempted to validate a new 2 hour accelerated diagnostic protocol to allow rapid discharge from the emergency department for patients presenting with chest pain who had 1) a TIMI score of zero, 2) a negative ECG, and 3) negative set of point of care cardiac biomarkers at zero and 2 hours. The authors found that 9.8% of patients could have potentially been discharged after only 2 hours with a sensitivity of 99.3% for an adverse cardiac event. JC attendees felt this article introduced an interesting idea, but needs further prospective validation in a North American setting before it is ready for use.
By: Dr. Brandon Ritcey
(Presented October 2013)
Epi lesson: Screening Test Sensitivity
A high quality screening test is one which is highly sensitive, often at the cost of lower specificity. A highly sensitive test helps one rule out a disease (SNout). It does so by demonstrating the ability to identify a high proportion of true positive cases relative to false negative cases (true positives/[false negatives + true positives]).
By: Dr. Lisa Calder