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Methods Inf Med 1986; 25(01): 43-46
DOI: 10.1055/s-0038-1635445
Original Artical
Schattauer GmbH

Discriminant Methods as Aids to the Diagnosis of Acute Coronary Heart Disease in the Emergency Room

Diskriminante Methoden zur Unterstützung bei der Diagnose von akuten koronaren Herzkrankheiten auf der Intensivstation
M. A. A. Moussa
1   From the Faculty of Medicine, Kuwait University
,
S. K. Bhatnagar
1   From the Faculty of Medicine, Kuwait University
,
A. R. Al-Yusuf
1   From the Faculty of Medicine, Kuwait University
› Author Affiliations
Further Information

Publication History

Publication Date:
20 February 2018 (online)

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Summary

Multivariate stepwise logistic regression and discriminant analyses were used to reduce emergency room data to the most relevant subset of variables that could improve the sensitivity and specificity of the diagnosis of acute coronary heart disease. Both procedures selected 5 out of 29 variables collected from 154 patients : abnormality of the ST segment in the electrocardiogram (ECG), shortness of breath, history of sublingual glyceryltrinitrate intake, chest pain duration >15 minutes, and previous history of a heart attack. The stepwise discriminant function selected additional variables: chest pain as the most important symptom, retrosternal site of chest pain and T wave abnormality on the ECG. The performance of the two methods was assessed by finding the classification matrix.

Multivariate, schrittweise logistische Regression und Diskriminanz-Analysen wurden angewandt, um Daten aus der Intensivstation auf die relevanteste Teilmenge von Variablen zurückzuführen, welche die Sensitivität und Spezifizität der Diagnose bei akuten koronaren Herzkrankheiten verbessern könnte. Bei beiden Verfahren wurden 5 von 29 bei 154 Patienten gesammelte Variable ausgewählt: Anomalität des ST-Segments beim Elektrokardiogramm (EKG), Kurzatmigkeit, sublinguale Glyzerintrinitrateinnahme in der Anamnese, Brustschmerzen während 15 Minuten und Herzanfall in der Vorgeschichte. Die schrittweise Diskriminanz ermittelte zusätzliche Variable: Brustschmerz als wichtigstes Symptom, retrosternaler Sitz des Brustschmerzes und T-Wellen-Anomalität im EKG. Die Leistung der beiden Methoden wurde durch Feststellung der Klassifikationsmatrix ermittelt.

Key-Words

Logistic Regression - Discriminant Analysis - Classification Matrix

Schlüssel-Wörter

Logistische Regression - Diskriminanzanalyse - Klassifikationsmatrix
 

  • REFERENCES

  • 1 Armitage P. Statistical Methods in Medical Research. Oxford: Blackwell Scientific Publications; 1973
    Search in Google Scholar
  • 2 Bloom B. S, Peterson O. L. End results, cost and productivity of coronary-care units. New Engl. J. Med 1973; 28: S72-78.
    PubMedSearch in Google Scholar
  • 3 Conti C. R, Brawley R. K, Griffith L. S. C. et al. Unstable angina pectoris morbidity and mortality in 57 consecutive patients evaluated angiographically. Amer. J. Cardiol 1973; 32: 745
    CrossrefPubMedSearch in Google Scholar
  • 4 Cox D. R. Analysis of Binary Data. London: Methuen and Co. Ltd; 1970
    Search in Google Scholar
  • 5 Engelman L. Stepwise logistic regression. In Dixon W. J, Brown M. B. (Eds) BMDP – Biomedical Computer Programs. Berkeley: University of California Press; 1979
    Search in Google Scholar
  • 6 Fuchs R, Scheldt S. Improved criteria for admission to cardiac care units. J. Amer. med. Ass 1981; 246: 2037-2041.
    CrossrefPubMedSearch in Google Scholar
  • 7 Goldman L, Weinberg M, Weisberg M. et al. A computer-derived protocol to aid in the diagnosis of emergency room patients with acute chest pain. New Engl. J. Med 1982; 307: 588-596.
    CrossrefPubMedSearch in Google Scholar
  • 8 Jennrich R, Sampson P. Stepwise discriminant analysis. In Dixon W. J, Brown M. B. (Eds) BDMP – Biomedical Computer Programs. Berkeley: University of California Press; 1979
    Search in Google Scholar
  • 9 Lachenbruch P, Mickey R. M. Estimation of error rates in discriminant analysis. Technometrics 1968; 10: 1-11.
    CrossrefPubMedSearch in Google Scholar
  • 10 McGuinness J. B, Begg T. B, Semple X. First electrocardiogram in recent myocardial infarction. Brit. med. J 1976; II: 449-451.
    PubMedSearch in Google Scholar
  • 11 Pozen M. W, D’Agostino R. B, Mitchell J. B. et al. The usefulness of predictive instrument to reduce inappropriate admission to the coronary care unit. Ann. intern. Med 1980; 92: 238-242.
    CrossrefPubMedSearch in Google Scholar
  • 12 Pozen M. W, D’Agostino R. B, Selker H. P. et al. A predictive instrument to improve coronary-care unit admission practices in acute ischemic heart disease -A prospective multicenter clinical trial. New Engl. J. Med 1984; 310: 1273-1278.
    CrossrefPubMedSearch in Google Scholar
  • 13 Schmitz P. I. M, Habbema J. D.E, Hermans J. The performance of logistic discrimination on myocardial infarction data, in comparison with some other discriminant analysis. Statist. Med 1983; 2: 199-205.
    CrossrefPubMedSearch in Google Scholar
  • 14 Van der Does E, Lubsen J. The imminent myocardial infarction Rotterdam study. The Netherlands: Report from the Thorax Centre, Rotterdem; January 1978
    Search in Google Scholar