Medical care
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Multicenter Study Clinical Trial
A tool for judging coronary care unit admission appropriateness, valid for both real-time and retrospective use. A time-insensitive predictive instrument (TIPI) for acute cardiac ischemia: a multicenter study.
This study developed and tested a tool to assess the likelihood of patients having acute cardiac ischemia and thus the appropriateness of admitting them to the coronary care unit (CCU). It is valid both for real-time clinical use and for retrospective review: a time-insensitive predictive instrument (TIPI). The authors' earlier acute ischemia predictive instrument, not designed specifically to support retrospective use, could not offer the advantage of a single tool usable by both clinicians and reviewers of care. ⋯ This differentiation was maintained even for those given different (including inappropriate) triage to the CCU, ward, or home (P less than 0.0001 for each disposition). When the performance of the four TIPI-based risk groups was prospectively tested on year-two patients, among the 552 patients in the low probability group, only 1.6% had acute cardiac ischemia, including only 0.7% with acute infarctions. Among the 484 patients in the high probability group, 81.6% had acute ischemia, and 53.3% acute myocardial infarctions, suggesting these to be clinically relevant groups for aiding or assessing emergency room triage.(ABSTRACT TRUNCATED AT 400 WORDS)