INFLUENCE OF PSEUDODIAGNOSTIC INFORMATION ON THE EVALUATION OF ISCHEMIC-HEART-DISEASE

Study objectives: To measure the influence of classic epidemiologic ri sk factors (as recorded on the chart) on physicians' admission decisio nmaking for patients with suspected acute cardiac ischemia and to comp are the influence of those risk factors, which are of limited predicti ve utility, to the influence of predictively useful information. Desig n: Retrospective chart review. Setting: Emergency departments of two c ommunity hospitals. Participants: Seven hundred eighty-seven patients evaluated for suspected acute cardiac ischemia, whether admitted or no t. Results: Logistic regression revealed that the effect of a recorded history of hypertension on the admission decision (OR, 7.89; 95% Cl, 4.57 to 13.58) was greater than that for ST-segment changes on the ECG (OR, 3.98; 95% Cl, 2.56 to 6.18) or history of infarction (OR, 2.36; 95% Cl, 1.53 to 3.62). A recorded history of diabetes had a small effe ct (OR, 1.84; 95% Cl, 1.01 to 3.36), whereas Q waves and T-wave change s were not statistically significant. Conclusion: Physicians' admissio n decisions appeared to be more heavily influenced by pseudodiagnostic information than by information of objective predictive power. Physic ians do not appear to distinguish risk factors from diagnostic informa tion; education may be directed at this distinction.