Affiliation:
1. College of Nursing, University of Illinois at Chicago, Chicago, IL
2. College of Nursing, University of Arizona, Tucson, AZ
3. Oregon Health & Science University, Portland, OR
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.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
82 articles.
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