Body surface mapping versus the standard 12 lead ECG in the detection of myocardial infarction amongst Emergency Department patients: a Bayesian approach.

Simon Carley, Michelle Jenkins, Kevin Mackway-Jones

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

OBJECTIVE: To determine if body surface mapping (BSM) is better than the standard 12 lead ECG in the diagnosis of acute myocardial infarction amongst emergency department patients. SETTING: A University affiliated inner-city emergency department. PARTICIPANTS: People presenting to an emergency department with symptoms compatible with myocardial ischaemia/infarction. MAIN OUTCOME MEASURES: Myocardial infarction as defined by either standard 12 lead ECG changes with associated cardiac marker rise, Troponin T >0.1 microg/ml at > 12 h or autopsy/surgical findings of fresh macroscopic infarction. RESULTS: BSM had an overall sensitivity of 47.1% versus 40% for the 12 lead ECG (P < 0.001). Specificity for the BSM was 85.6% versus 93.7% for the 12 lead ECG (P < 0.001). These findings were consistent for low/moderate and high risk subgroups. Bayesian analysis demonstrates that indiscriminate use of BSM would result in a clinically important overdiagnosis of myocardial infarction amongst emergency department patients. CONCLUSIONS: BSM has a higher sensitivity, but a lower specificity for the diagnosis of myocardial infarction.
Original languageEnglish
Pages (from-to)309-314
JournalResuscitation
Volume64
Issue number3
Publication statusPublished - Mar 2005

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Body Surface Potential Mapping
Bayes Theorem
Hospital Emergency Service
Electrocardiography
Myocardial Infarction
Troponin T
Infarction
Myocardial Ischemia
Autopsy
Lead

Cite this

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abstract = "OBJECTIVE: To determine if body surface mapping (BSM) is better than the standard 12 lead ECG in the diagnosis of acute myocardial infarction amongst emergency department patients. SETTING: A University affiliated inner-city emergency department. PARTICIPANTS: People presenting to an emergency department with symptoms compatible with myocardial ischaemia/infarction. MAIN OUTCOME MEASURES: Myocardial infarction as defined by either standard 12 lead ECG changes with associated cardiac marker rise, Troponin T >0.1 microg/ml at > 12 h or autopsy/surgical findings of fresh macroscopic infarction. RESULTS: BSM had an overall sensitivity of 47.1{\%} versus 40{\%} for the 12 lead ECG (P < 0.001). Specificity for the BSM was 85.6{\%} versus 93.7{\%} for the 12 lead ECG (P < 0.001). These findings were consistent for low/moderate and high risk subgroups. Bayesian analysis demonstrates that indiscriminate use of BSM would result in a clinically important overdiagnosis of myocardial infarction amongst emergency department patients. CONCLUSIONS: BSM has a higher sensitivity, but a lower specificity for the diagnosis of myocardial infarction.",
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Body surface mapping versus the standard 12 lead ECG in the detection of myocardial infarction amongst Emergency Department patients: a Bayesian approach. / Carley, Simon; Jenkins, Michelle; Mackway-Jones, Kevin.

In: Resuscitation, Vol. 64, No. 3, 03.2005, p. 309-314.

Research output: Contribution to journalArticle

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AU - Jenkins, Michelle

AU - Mackway-Jones, Kevin

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N2 - OBJECTIVE: To determine if body surface mapping (BSM) is better than the standard 12 lead ECG in the diagnosis of acute myocardial infarction amongst emergency department patients. SETTING: A University affiliated inner-city emergency department. PARTICIPANTS: People presenting to an emergency department with symptoms compatible with myocardial ischaemia/infarction. MAIN OUTCOME MEASURES: Myocardial infarction as defined by either standard 12 lead ECG changes with associated cardiac marker rise, Troponin T >0.1 microg/ml at > 12 h or autopsy/surgical findings of fresh macroscopic infarction. RESULTS: BSM had an overall sensitivity of 47.1% versus 40% for the 12 lead ECG (P < 0.001). Specificity for the BSM was 85.6% versus 93.7% for the 12 lead ECG (P < 0.001). These findings were consistent for low/moderate and high risk subgroups. Bayesian analysis demonstrates that indiscriminate use of BSM would result in a clinically important overdiagnosis of myocardial infarction amongst emergency department patients. CONCLUSIONS: BSM has a higher sensitivity, but a lower specificity for the diagnosis of myocardial infarction.

AB - OBJECTIVE: To determine if body surface mapping (BSM) is better than the standard 12 lead ECG in the diagnosis of acute myocardial infarction amongst emergency department patients. SETTING: A University affiliated inner-city emergency department. PARTICIPANTS: People presenting to an emergency department with symptoms compatible with myocardial ischaemia/infarction. MAIN OUTCOME MEASURES: Myocardial infarction as defined by either standard 12 lead ECG changes with associated cardiac marker rise, Troponin T >0.1 microg/ml at > 12 h or autopsy/surgical findings of fresh macroscopic infarction. RESULTS: BSM had an overall sensitivity of 47.1% versus 40% for the 12 lead ECG (P < 0.001). Specificity for the BSM was 85.6% versus 93.7% for the 12 lead ECG (P < 0.001). These findings were consistent for low/moderate and high risk subgroups. Bayesian analysis demonstrates that indiscriminate use of BSM would result in a clinically important overdiagnosis of myocardial infarction amongst emergency department patients. CONCLUSIONS: BSM has a higher sensitivity, but a lower specificity for the diagnosis of myocardial infarction.

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