Sensitivity, specificity, and sex differences in symptoms reported on the 13-item acute coronary syndrome checklist.

Holli A. Devon, Anne G Rosenfeld, Alana D. Steffen, Mohamud Daya

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

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. The sample included 736 patients admitted to 4 EDs 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. There were more similarities than differences in symptom predictors of ACS for women and men.

Original languageEnglish (US)
JournalJournal of the American Heart Association
Volume3
Issue number2
DOIs
StatePublished - 2014

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Acute Coronary Syndrome
Checklist
Sex Characteristics
Sensitivity and Specificity
Odds Ratio
Thorax
Logistic Models
Chest Pain
Dyspnea
Hospital Emergency Service
Arm
Obesity
Pressure
Pain

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sensitivity, specificity, and sex differences in symptoms reported on the 13-item acute coronary syndrome checklist. / Devon, Holli A.; Rosenfeld, Anne G; Steffen, Alana D.; Daya, Mohamud.

In: Journal of the American Heart Association, Vol. 3, No. 2, 2014.

Research output: Contribution to journalArticle

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