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Emerg Med J 26:866-870 doi:10.1136/emj.2008.064428
  • Original Article

Clinical diagnosis of acute coronary syndrome in patients with chest pain and a normal or non-diagnostic electrocardiogram

Table 5

Sensitivity, specificity and likelihood ratios for each variable

Feature Sensitivity Specificity Positive likelihood ratio Negative likelihood ratio
Male sex 86/132 (65.2%) 635/1444 (44.0%) 1.16 (1.02 to 1.33) 0.792 (0.623 to 1.01)
Nature of chest pain
    Indigestion/burning 16/129 (12.4%) 1307/1426 (91.7%) 1.49 (0.91 to 2.43) 0.956 (0.894 to 1.02)
    Stabbing/sharp 18/129 (14.0%) 1133/1426 (79.5%) 0.679 (0.437 to 1.06) 1.08 (1.0 to 1.17)
    Aching/dull/heavy 59/129 (45.7%) 774/1426 (54.3%) 1.0 (0.822 to 1.22) 1.0 (0.847 to 1.18)
    Gripping/crushing 25/129 (19.4%) 1219/1426 (85.5%) 1.33 (0.919 to 1.94) 0.943 (0.864 to 1.03)
    Non-specific/other 11/129 (8.5%) 1271/1426 (89.1%) 0.784 (0.437 to 1.41) 1.03 (0.971 to 1.08)
Site of chest pain
    Central 101/131 (77.7%) 424/1431 (29.6%) 1.10 (0.992 to 1.21) 0.773 (0.559 to 1.07)
    Left chest 18/131 (13.7%) 1141/1431 (79.7%) 0.678 (0.436 to 1.05) 1.08 (1.01 to 1.16)
    Right chest 1/131 (0.8%) 1396/1431 (97.6%) 0.312 (0.043 to 2.26) 1.02 (1.0 to 1.04)
    Other 11/131 (8.4%) 1332/1431 (93.1%) 1.21 (0.668 to 2.20) 0.984 (0.933 to 1.04)
Radiation of chest pain
    None 43/130 (33.1%) 842/1404 (60.0%) 0.826 (0.642 to 1.06) 1.12 (0.982 to 1.27)
    Left arm 45/130 (34.6%) 993/1404 (70.7%) 1.18 (0.921 to 1.52) 0.924 (0.812 to 1.05)
    Right arm 9/130 (6.9%) 1374/1404 (97.9%) 3.24 (1.57 to 6.68) 0.951 (0.907 to 0.997)
    Neck 5/130 (3.8%) 1331/1404 (94.8%) 0.740 (0.304 to 1.80) 1.01 (0.978 to 1.05)
    Jaw 3/130 (2.3%) 1347/1404 (95.9%) 0.568 (0.181 to 1.79) 1.02 (0.990 to 1.05)
    Back 11/130 (8.5%) 1241/1404 (88.4%) 0.729 (0.407 to 1.31) 1.04 (0.980 to 1.09)
    Other 14/130 (10.8%) 1296/1404 (92.3%) 1.40 (0.827 to 2.37) 0.967 (0.909 to 1.03)
Time of onset
    00:00–05:59 26/121 (21.5%) 1060/1288 (82.3%) 1.21 (0.847 to 1.74) 0.954 (0.866 to 1.05)
    06:00–11:59 50/121 (41.3%) 663/1288 (51.5%) 0.852 (0.684 to 1.06) 1.14 (0.973 to 1.34)
    12:00–17:59 24/121 (19.8%) 1048/1288 (81.4%) 1.06 (0.731 to 1.55) 0.985 (0.898 to 1.08)
    18:00–23:59 21/121 (17.4%) 1129/1288 (87.7%) 1.41 (0.928 to 2.13) 0.943 (0.867 to 1.03)
    Continuous 74/111 (66.7%) 393/1192 (33.0%) 0.995 (0.867 to 1.14) 1.01 (0.768 to 1.33)
Nausea 43/127 (33.9%) 948/1394 (68.0%) 1.06 (0.820 to 1.36) 0.973 (0.854 to 1.11)
Vomiting 9/125 (7.2%) 1293/1376 (94.0%) 1.19 (0.615 to 2.32) 0.988 (0.939 to 1.04)
Sweating 59/128 (46.1%) 808/1393 (58.0%) 1.10 (0.909 to 1.34) 0.929 (0.787 to 1.10)
Dyspnoea 49/126 (38.9%) 822/1381 (59.5%) 0.961 (0.765 to 1.21) 1.03 (0.887 to 1.19)
Previous coronary heart disease 16/127 (12.6%) 1227/1407 (87.2%) 0.985 (0.611 to 1.59) 1.0 (0.935 to 1.07)
Diabetes 7/128 (5.5%) 1309/1396 (93.8%) 0.878 (0.415 to 1.85) 1.01 (0.965 to 1.05)
Hypertension 52/129 (40.3%) 975/1382 (70.5%) 1.37 (1.09 to 1.71) 0.846 (0.731 to 0.979)
Hyperlipidaemia 37/118 (31.4%) 937/1300 (72.1%) 1.12 (0.848 to 1.49) 0.952 (0.839 to 1.08)
Smoker 36/126 (28.6%) 944/1386 (68.1%) 0.896 (0.673 to 1.19) 1.05 (0.934 to 1.79)
Ex-smoker 26/123 (21.1%) 1145/1326 (86.3%) 1.55 (1.07 to 2.24) 0.913 (0.831 to 1.0)
Cocaine use 0/122 (0%) 1300/1323 (98.3%)
Family history 48/119 (40.3%) 706/1303 (54.2%) 0.880 (0.702 to 1.10) 1.10 (0.942 to 1.29)
Chest wall 4/108 (3.7%) 1181/1259 (93.8%) 0.598 (0.223 to 1.60) 1.03 (0.987 to 1.07)
  • Differences in denominators for sensitivity and specificity are due to missing data.

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