Diagnostic accuracy of strategies incorporating physician gestalt
| Strategy | Sensitivity | Specificity | PPV | NPV |
|---|---|---|---|---|
| Gestalt alone (‘probably not’ ACS discharged)* | 95.1 (87.8 to 98.6) | 31.8 (27.2 to 36.8) | 23.1 (18.6 to 28.0) | 96.8 (92.0 to 99.1) |
| Gestalt alone (only ‘probable’ and ‘definite’ ACS admitted)† | 71.6 (60.5 to 81.1) | 69.2 (64.3 to 73.9) | 33.3 (26.4 to 40.9) | 91.8 (88.1 to 94.8) |
| Gestalt+TnT+ECG‡ | 100.0 (95.6 to 100.0) | 28.0 (23.5 to 32.8) | 23.1 (18.8 to 27.8) | 100.0 (96.6 to 100.0) |
| Gestalt+hs-TnT+ECG§ | 100.0 (95.4 to 100.0) | 22.8 (18.6 to 27.4) | 21.5 (17.4 to 26.1) | 100.0 (95.7 to 100.0) |
| Gestalt+hs-TnT+ECG (only ‘probable’ and ‘definite’ ACS admitted)¶ | 100.0 (95.4 to 100.0) | 46.6 (41.4 to 51.9) | 28.4 (23.1 to 34.1) | 100.0 (97.9 to 100.0) |
*This strategy would mean that patients are discharged if the clinician believed the diagnosis was ‘definitely not’ or ‘probably not’ ACS. All other patients would be admitted.
†This strategy would mean that patients are discharged if the clinician believed the diagnosis was ‘definitely not’, ‘probably not’ or ‘could be’ ACS. Only those with ‘probable’ or ‘definite’ ACS would be admitted.
‡N=456.
§Retested hs-cTnT. N=447.
¶This strategy would mean that patients would be discharged if they had no ECG ischaemia, a normal hs-TnT level on arrival and if the clinician felt the diagnosis was ‘definitely not’, ‘probably not’ or ‘could be’ ACS. Other patients would be admitted.
ACS, acute coronary syndrome.