Accuracy of history and physical examination for detecting acute myocardial infarction – a hospital based diagnostic accuracy study
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2018, Vol 3, Issue 7
Abstract
Although acute myocardial infarction (AMI) is a common disorder that makes people seek emergency healthcare, there is little evidence on the diagnostic accuracy of symptoms and signs, for the diagnosis of acute myocardial infarction. This study was conducted in Intensive Care Unit of a rural teaching hospital in central India. It was a hospital based cross-sectional diagnostic accuracy study. We followed STARD guidelines for conducting and reporting the study: (i) we consecutively enrolled all inpatients suspected to have and admitted to intensive care unit during a specified period. (ii) We did a blind and independent comparison of the index tests (symptoms and signs) with the reference standard (ECG). (iii) Every patient received both index test as well as reference standard regardless of the results of the either. 450 patients aged 30 years and over (279 men and 171 women) admitted with acute chest pain to the intensive care unit and suspected to have acute myocardial infarction were finally included. Index tests: 1. History: Chest pain (character, location, radiation, aggravating and relieving factors) 2. Risk factors: Personal history of hypertension, diabetes, angina, smoking 3. Physical examination: Third heart sound, crackles, chest tenderness 4. ECG: ST-segment elevation or depression, T waves peaking or inversion, Q waves Reference standard: 12-lead electrocardiogram (ECG) for history and physical examination; discharge diagnoses for ECG Statistical Software: Stata, version 12 ( Stata Corporation, Texas, USA). The results of the final model are presented as adjusted odds ratios (OR) with 95% confidence intervals. Results: Of the 481 patients enrolled, we evaluated 450 patients (279 (62%) men and 171 women (38%); aged 20 years to 90 years [mean 57.7(SD 12.9) years]. In a multivariate logistic regression model, following features of history and physical examination emerged as independent predictors of AMI: crushing chest pain (OR 10.3), pain radiating to the right arm (OR 5.4), heavy chest (OR 3.3), burning character of chest pain (OR 3.3), male sex (OR 2.0), sweating (OR 1.9), apprehension (OR 1.7), pain relieved with nitroglycerine (OR 1.8), and pain radiating to both shoulders (OR 1.6). Third heart sound and crackles were both associated with OR of 2.3 each while chest tenderness yielded an OR of 0.25. Conclusion: Even in a high prevalence setting, no sign or symptom exhibited by patients presenting with possible acute MI proved effective enough alone to rule in or out AMI.
Authors and Affiliations
Ajit Kumar Srivastava
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