Sensitivity, Specificity, and Sex Differences in Symptoms Reported on the 13‐Item Acute Coronary Syndrome Checklist

Abstract

Background Clinical symptoms are part of the risk stratification approaches used in the emergency department ( ED ) to evaluate patients with suspected acute coronary syndromes ( ACS ). The objective of this study was to determine the sensitivity, specificity, and predictive value of 13 symptoms for a discharge diagnosis of ACS in women and men. Methods and Results The sample included 736 patients admitted to 4 ED s with symptoms suggestive of ACS . Symptoms were assessed with the 13‐item validated ACS Symptom Checklist. Mixed‐effects logistic regression models were used to estimate sensitivity, specificity, and predictive value of each symptom for a diagnosis of ACS , adjusting for age, obesity, diabetes, and functional status. Patients were predominantly male (63%) and Caucasian (70.5%), with a mean age of 59.7±14.2 years. Chest pressure, chest discomfort, and chest pain demonstrated the highest sensitivity for ACS in both women (66%, 66%, and 67%) and men (63%, 69%, and 72%). Six symptoms were specific for a non‐ ACS diagnosis in both women and men. The predictive value of shoulder (odds ratio [ OR] =2.53; 95% CI =1.29 to 4.96) and arm pain ( OR 2.15; 95% CI =1.10 to 4.20) in women was nearly twice that of men ( OR =1.11; 95% CI =0.67 to 1.85 and OR =1.21; 95% CI =0.74 to 1.99). Shortness of breath ( OR =0.49; 95% CI =0.30 to 0.79) predicted a non‐ ACS diagnosis in men. Conclusions There were more similarities than differences in symptom predictors of ACS for women and men.