A Tool for Judging Coronary Care Unit Admission Appropriateness, Valid for Both Real-Time and Retrospective Use: A Time-Insensitive Predictive Instrument (TIPI) for Acute Cardiac Ischemia: A Multicenter Study

@article{Selker1991ATF,
  title={A Tool for Judging Coronary Care Unit Admission Appropriateness, Valid for Both Real-Time and Retrospective Use: A Time-Insensitive Predictive Instrument (TIPI) for Acute Cardiac Ischemia: A Multicenter Study},
  author={Harry P. Selker and John L. Griffith and Ralph B. D' Agostino},
  journal={Medical Care},
  year={1991},
  volume={29},
  pages={610-627}
}
This study developed and tested a tool to assess the likelihood of patients having acute cardiac ischemia and thus the appropriateness of admitting them to the coronary care unit (CCU). It is valid both for real-time clinical use and for retrospective review: a time-insensitive predictive instrument (TIPI). The authors' earlier acute ischemia predictive instrument, not designed specifically to support retrospective use, could not offer the advantage of a single tool usable by both clinicians… 
Impact of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) on the speed of triage decision making for emergency department patients presenting with chest pain
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For ED patients with acute cardiac ischemia evaluated by novice clinicians, the ACI-TIPI substantially speeded ED decision making and triage, and the suggestion of an impact on different cardiac isChemia subgroups and mortality deserves further larger clinical trials.
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Use of the Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI) To Assist with Triage of Patients with Chest Pain or Other Symptoms Suggestive of Acute Cardiac Ischemia: A Multicenter, Controlled Clinical Trial
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A clinical trial is reported to test the effect of electrocardiogram-based ACI-TIPI on emergency department triage of patients with chest pain or other symptoms suggestive of acute cardiac ischemia and whether its use would reduce unnecessary hospital and CCU admission for emergency department patients without cardiac ischemic disease or with stable angina pectoris while not reducing hospitalization.
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  • 2001
In the United States, acute cardiac ischemia (ACI), including both unstable angina pectoris and acute myocardial infarction (AMI), is the leading cause of morbidity and mortality, and an enormous
Physician Decision Making and Variation in Hospital Admission Rates for Suspected Acute Cardiac Ischemia: A Tale of Two Towns
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It is concluded that, at least for ACI, population-based area discharge rates do not necessarily reflect case-based decision rates.
A Time‐Insensitive Predictive Instrument for Acute Hospital Mortality Due to Congestive Heart Failure: Development, Testing, and Use for Comparing Hospitals A Multicenter Study
TLDR
This congestive heart failure mortality TIPI shows potential for risk-adjusted studies of hospitals, mortality for multi-hospital groups, hospital-to-hospital comparisons, and potentially for within-hospital assessment and if further validated, potentially also for real-time clinical use.
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References

SHOWING 1-10 OF 11 REFERENCES
A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease. A prospective multicenter clinical trial.
TLDR
A predictive instrument for use in a hand-held programmable calculator, which requires only 20 seconds to compute a patient's probability of having acute cardiac ischemia, could reduce the number of CCU admissions in this country by more than 250,000 per year.
A computer protocol to predict myocardial infarction in emergency department patients with chest pain.
TLDR
Although this protocol should not be used to override careful clinical judgment in individual cases, the computer protocol for the most part yields accurate estimates of the probability of myocardial infarction.
Optimal Identification of the Patient with Acute Myocardial Ischemia in the Emergency Room
TLDR
This chapter reviews studies that have attempted to optimize AIHD diagnostic accuracy in the ER setting and suggests that even a modest improvement in admitting practices would yield substantial savings.
Care of patients with a low probability of acute myocardial infarction. Cost effectiveness of alternatives to coronary-care-unit admission.
TLDR
A cost-effectiveness analysis of alternatives to admission to a coronary-care unit for patients who have a relatively low probability of acute myocardial infarction shows that admission to an intermediate- Care unit providing resuscitative facilities and prophylactic lidocaine is highly cost effective.
Patient Needs and Medical-Care Planning
TLDR
Using Framingham Heart Study incidence data for acute and serious heart disease, it is suggested that 5.6 million people can be served by 39 coronary-care units with 336 beds, as contrasted with the 94 units with 446 beds currently in Massachusetts.
Inappropriate use of intensive care.
  • B. Jennett
  • Medicine, Political Science
    British medical journal
  • 1984
TLDR
Intensive care can influence outcome in only a limited subset of patients; and even in such patients the details of the regimens and technologies may matter less than the advantage that accrues from attracting intensive attention from doctors and nurses.
The use of intensive care: new research initiatives and their implications for national health policy.
TLDR
Together, these studies form a strong argument that medical care costs in the United States are too high because American citizens do not benefit from much of the medical care they currently receive.
Distributing Medical Care Services: Coronary Care Units in the United States and Sweden
  • B. Bloom, E. Jonsson
  • Political Science, Medicine
    Scandinavian journal of social medicine
  • 1978
TLDR
Physicians and the public appear able to adjust to the quite different resource provisions of the two planning systems; both the abundant U.S. supply and the restricted supply in Sweden are perceived as adequate.
Statistical methods for rates and proportions
TLDR
An Introduction to Applied Probability: The Basic Theory of Maximum Likelihood Estimation and Answers to Selected Problems.
...
1
2
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