Adding quantitative pre-test probability to CP

In this single institutional study of low risk chest pain patients (symptoms but no ischemia on EKG), ED physicians were randomly assigned to receive a quantitative pre-test probability of ACS, based on patient factors. Of those patients who ended up not having any CV diagnosis, those in the intervention group were less likely to get admitted (5% versus 11% of controls), less likely to recieve an imaging test (9% versus 19%) and were more likely to be satisfied with the explanation of their condition from the physician (49% versus 38%) (abstract). This adds to the literature that decision support, with quantitative pre-test probabilities, can improve physician decision making, resulting in less resource utilization and higher patient satisfaction. For a copy of the decision support used in this study, see appendix E1 on-line (decision support).

Danielle Scheurer

Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.

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