Elsevier

Annals of Emergency Medicine

Volume 18, Issue 9, September 1989, Pages 953-963
Annals of Emergency Medicine

Original contribution
How many myocardial infarctions should we rule out?

https://doi.org/10.1016/S0196-0644(89)80460-3Get rights and content

We used computer simulation to estimate the consequences of four admitting strategies (coronary care unit, intermediate care unit, routine ward care, or outpatient follow-up) on cost, outcome, admission threshold probabilities, and false-positive admission rates for patients with acute myocardial infarction. At virtually any probability of acute myocardial infarction, replacing more intensive by less intensive strategies saved money but increased mortality and decreased life expectancy. Therefore, choices among strategies may be made by using the most effective strategy for progressively lower and lower risk patients until the additional cost per additional life saved reaches a cutoff value; then, a less expensive strategy is selected. With sample cutoff values of $1 and $2 million per life saved, the marginal threshold admission probabilities were:

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Presented at the University Association for Emergency Medicine Annual Meeting in Philadelphia, May 1987.

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