CRITERIA-BASED EXPERT-SYSTEM FOR CARDIAC ISCHEMIA EVALUATION IN THE EMERGENCY DEPARTMENT

Objective: To develop and evaluate a cardiac ischemia computer expert system using a criteria-based expert shell for assessment of chest pai n patients in a community hospital ED setting, Methods: A retrospectiv e, comparison study of the expert system against the clinical judgment of board-certified emergency physicians (EPs) was performed in 1 comm unity hospital ED. All chest pain patients had either a cardiac cathet erization, Persantine stress testing, or both within 1 month of ED pre sentation. A final diagnosis of acute myocardial infarction or unstabl e angina by a consultant cardiologist represented the criterion standa rd for cardiac ischemia. Results: Of the 59 patients meeting study cri teria, 28 (47%) had cardiac ischemia. The expert system had equal sens itivity (100%) and was more than twice as specific (39% vs 16%) in dia gnosing ischemic cardiac disease as were the board-certified EPs (p < 0.001; McNemar's chi-square with Yates' correction). Conclusions: The criteria-based system built around a system of findings ordered by Bay es' rule has potential augment the ability of the EP to accurately dia gnose ischemic heart disease.