All patients entering the emergency room with a chief complaint of chest pain are first evaluated with respect to vital signs,
general appearance, EKG changes, and cardiac enzymes elevations. These initial questions will identify certain patients that
require immediate treatment and disposition. Such patients are not deemed appropriate for inclusion in the database. These
questions eventually will be utilized as 'early triage' prior to utilization of the predictive modeling tool.
A series of consecutive patients with acute chest pain are chosen from the remaining group, who now fit into the specific
tier of ACC/AHA guidelines termed 'indefinite/indeterminate for ischemia' as determined by the ER
For each patient, the available ER chest pain algorithm, containing a series of clinical questions, is completed and recorded, along with diagnosis/management recommendations.
The questions in the algorithm are assembled in standard clinical format: HPI, PMH, meds, FH, SH, ROS, PE, labs, and CXR.
Potential diagnostic outcomes of the decision tool include the 29 most common diagnoses of patients presenting with chest pain in an ER setting, according to the literature.
Assembling the Tool Online, By the User, 'In the field'
Data from a requisite number of patients may be entered onto the HIPAA-compliant web site without the need for IT input.
Once completed, the 'tool', which is essentially a web-enabled neural network, is created. It is now ready for use.
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