{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T20:41:12Z","timestamp":1776112872296,"version":"3.50.1"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2005,8,11]],"date-time":"2005-08-11T00:00:00Z","timestamp":1123718400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"published-print":{"date-parts":[[2005,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Pretest probability (PTP) assessment plays a central role in diagnosis. This report compares a novel attribute-matching method to generate a PTP for acute coronary syndrome (ACS). We compare the new method with a validated logistic regression equation (LRE).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Eight clinical variables (attributes) were chosen by classification and regression tree analysis of a prospectively collected reference database of 14,796 emergency department (ED) patients evaluated for possible ACS. For attribute matching, a computer program identifies patients within the database who have the exact profile defined by clinician input of the eight attributes. The novel method was compared with the LRE for ability to produce PTP estimation &lt;2% in a validation set of 8,120 patients evaluated for possible ACS and did not have ST segment elevation on ECG. 1,061 patients were excluded prior to validation analysis because of ST-segment elevation (713), missing data (77) or being lost to follow-up (271).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>In the validation set, attribute matching produced 267 unique PTP estimates [median PTP value 6%, 1<jats:sup>st<\/jats:sup>\u20133<jats:sup>rd<\/jats:sup> quartile 1\u201310%] compared with the LRE, which produced 96 unique PTP estimates [median 24%, 1<jats:sup>st<\/jats:sup>\u20133<jats:sup>rd<\/jats:sup> quartile 10\u201330%]. The areas under the receiver operating characteristic curves were 0.74 (95% CI 0.65 to 0.82) for the attribute matching curve and 0.68 (95% CI 0.62 to 0.77) for LRE.<\/jats:p>\n            <jats:p>The attribute matching system categorized 1,670 (24%, 95% CI = 23\u201325%) patients as having a PTP &lt; 2.0%; 28 developed ACS (1.7% 95% CI = 1.1\u20132.4%). The LRE categorized 244 (4%, 95% CI = 3\u20134%) with PTP &lt; 2.0%; four developed ACS (1.6%, 95% CI = 0.4\u20134.1%).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Attribute matching estimated a very low PTP for ACS in a significantly larger proportion of ED patients compared with a validated LRE.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/1472-6947-5-26","type":"journal-article","created":{"date-parts":[[2005,8,12]],"date-time":"2005-08-12T18:13:54Z","timestamp":1123870434000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":99,"title":["Pretest probability assessment derived from attribute matching"],"prefix":"10.1186","volume":"5","author":[{"given":"Jeffrey A","family":"Kline","sequence":"first","affiliation":[]},{"given":"Charles L","family":"Johnson","sequence":"additional","affiliation":[]},{"suffix":"Jr","given":"Charles V","family":"Pollack","sequence":"additional","affiliation":[]},{"given":"Deborah B","family":"Diercks","sequence":"additional","affiliation":[]},{"given":"Judd E","family":"Hollander","sequence":"additional","affiliation":[]},{"given":"Craig D","family":"Newgard","sequence":"additional","affiliation":[]},{"given":"J Lee","family":"Garvey","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2005,8,11]]},"reference":[{"key":"77_CR1","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/BF02596149","volume":"2","author":"NV Dawson","year":"1987","unstructured":"Dawson NV, Arkes HR: Systematic errors in medical decision making: judgment limitations. [Review] [18 refs]. Journal of General Internal Medicine. 1987, 2: 183-187.","journal-title":"Journal of General Internal Medicine"},{"key":"77_CR2","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1136\/bmj.317.7155.405","volume":"317","author":"RJ Lilford","year":"1998","unstructured":"Lilford RJ, Pauker SG, Braunholtz DA, Chard J: Decision analysis and the implementation of research findings. [Review] [22 refs]. BMJ. 1998, 317: 405-409.","journal-title":"BMJ"},{"key":"77_CR3","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.1001\/jama.281.13.1214","volume":"281","author":"WS Richardson","year":"1999","unstructured":"Richardson WS, Wilson MC, Guyatt GH, Cook DJ, Nishikawa J: Users' guides to the medical literature: XV. How to use an article about disease probability for differential diagnosis. Evidence-Based Medicine Working Group. JAMA. 1999, 281: 1214-1219. 10.1001\/jama.281.13.1214.","journal-title":"JAMA"},{"key":"77_CR4","doi-asserted-by":"publisher","first-page":"1350","DOI":"10.1056\/NEJM197906143002402","volume":"300","author":"GA Diamond","year":"1979","unstructured":"Diamond GA, Forrester JS: Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. New England Journal of Medicine. 1979, 300: 1350-1358.","journal-title":"New England Journal of Medicine"},{"key":"77_CR5","first-page":"68","volume":"4","author":"WS Richardson","year":"1999","unstructured":"Richardson WS: Where do pretest probabilities come from?. ACP Journal Club. 1999, 4: 68-69.","journal-title":"ACP Journal Club"},{"key":"77_CR6","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1056\/NEJM198803313181301","volume":"318","author":"L Goldman","year":"1988","unstructured":"Goldman L, Cook EF, Brand DA, Lee TH, Rouan GW, Weisberg MC, Acampora D, Stasiulewicz C, Walshon J, Terranova G: A computer protocol to predict myocardial infarction in emergency department patients with chest pain. New England Journal of Medicine. 1988, 318: 797-803.","journal-title":"New England Journal of Medicine"},{"key":"77_CR7","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1001\/jama.288.3.342","volume":"288","author":"BM Reilly","year":"2002","unstructured":"Reilly BM, Evans AT, Schaider JJ, Das K, Calvin JE, Moran LA, Roberts RR, Martinez E: Impact of a clinical decision rule on hospital triage of patients with suspected acute cardiac ischemia in the emergency department. JAMA. 2002, 288: 342-350. 10.1001\/jama.288.3.342.","journal-title":"JAMA"},{"key":"77_CR8","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1067\/mem.2002.129171","volume":"40","author":"WG Baxt","year":"2002","unstructured":"Baxt WG, Shofer FS, Sites FD, Hollander JE: A neural network aid for the early diagnosis of cardiac ischemia in patients presenting to the emergency department with chest pain. Ann Em Med. 2002, 40: 575-583. 10.1067\/mem.2002.129171.","journal-title":"Ann Em Med"},{"key":"77_CR9","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1056\/NEJM198405173102001","volume":"310","author":"MW Pozen","year":"1984","unstructured":"Pozen MW, D'Agostino RB, Selker HP, Sytkowski PA, Hood WBJ: A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease. A prospective multicenter clinical trial. New England Journal of Medicine. 1984, 310: 1273-1278.","journal-title":"New England Journal of Medicine"},{"key":"77_CR10","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1001\/jama.284.7.835","volume":"284","author":"EM Antman","year":"2000","unstructured":"Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, Mautner B, Corbalan R, Radley D, Braunwald E: The TIMI risk score for unstable angina\/non-ST elevation MI: A method for prognostication and therapeutic decision making.[comment]. JAMA. 2000, 284: 835-842. 10.1001\/jama.284.7.835.","journal-title":"JAMA"},{"key":"77_CR11","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1016\/S0196-0644(00)70006-0","volume":"35","author":"AB Storrow","year":"2000","unstructured":"Storrow AB, Gibler WB: Chest pain centers: diagnosis of acute coronary syndromes. Ann Emerg Med. 2000, 35: 449-461.","journal-title":"Ann Emerg Med"},{"key":"77_CR12","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1056\/NEJM198005153022003","volume":"302","author":"SG Pauker","year":"1980","unstructured":"Pauker SG, Kassirer JP: The threshold approach to clinical decision making. New England Journal of Medicine. 1980, 302: 1109-1117.","journal-title":"New England Journal of Medicine"},{"key":"77_CR13","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1111\/j.1553-2712.2003.tb01991.x","volume":"10","author":"AL Blomkalns","year":"2003","unstructured":"Blomkalns AL, Lindsell CJ, Chandra A, Osterlund ME, Gibler WB, Pollack CV, Tiffany BR, Hollander JE, Hoekstra JW: Can electrocardiographic criteria predict adverse cardiac events and positive cardiac markers?. Academic Emergency Medicine. 2003, 10: 205-210. 10.1197\/aemj.10.3.205.","journal-title":"Academic Emergency Medicine"},{"key":"77_CR14","volume-title":"Classification and regression trees","author":"L Breiman","year":"1984","unstructured":"Breiman L, Friedman JH, Stone CJ: Classification and regression trees. 1984, New York, Chapman & Hall (Wadsworth, Inc.)"},{"key":"77_CR15","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/S0002-9343(03)00328-0","volume":"115","author":"JA Kline","year":"2003","unstructured":"Kline JA, Hernandez J, Newgard CD, Cowles DN, Jackson RE, Courtney DM: Use of pulse oximetry to predict in-hospital complications in normotensive patients with pulmonary embolism. American Journal of Medicine. 2003, 115: 203-208. 10.1016\/S0002-9343(03)00328-0.","journal-title":"American Journal of Medicine"},{"key":"77_CR16","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1097\/00005650-199107000-00002","volume":"29","author":"HP Selker","year":"1991","unstructured":"Selker HP, Griffith JL, D'Agostino RB: A tool for judging coronary care unit admission appropriateness, valid for both real-time and retrospective use. A time-Insensitive predictive instrument (TIPI) for acute cardiac ischemia: A multicenter study. Medical Care. 1991, 29: 610-626.","journal-title":"Medical Care"},{"key":"77_CR17","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1067\/mem.2001.114903","volume":"37","author":"J Lau","year":"2001","unstructured":"Lau J, Ioannidis JP, Balk EM, Milch C, Terrin N, Chew PW, Salem D: Diagnosing acute cardiac ischemia in the emergency department: a systematic review of the accuracy and clinical effect of current technologies. Ann Emerg Med. 2001, 37: 453-460. 10.1067\/mem.2001.114903.","journal-title":"Ann Emerg Med"},{"key":"77_CR18","doi-asserted-by":"publisher","first-page":"845","DOI":"10.7326\/0003-4819-129-11_Part_1-199812010-00002","volume":"129","author":"HP Selker","year":"1998","unstructured":"Selker HP, Beshansky JR, Griffith JL, Aufderheide TP, Ballin DS, Bernard SA, Crespo SG, Feldman JA, Fish SS, Gibler WB, Kiez DA, McNutt RA, Moulton AW, Ornato JP, Podrid PJ, Pope JH, Salem DN, Sayre MR, Woolard RH: Use of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) to assist with triage of patients with chest pain or other symptoms suggestive of acute cardiac ischemia. A multicenter, controlled clinical trial. Annals of Internal Medicine. 1998, 129: 845-855.","journal-title":"Annals of Internal Medicine"},{"key":"77_CR19","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1067\/mhj.2002.124048","volume":"144","author":"FS Apple","year":"2002","unstructured":"Apple FS, Wu AH, Jaffe AS: European Society of Cardiology and American College of Cardiology guidelines for redefinition of myocardial infarction: how to use existing assays clinically and for clinical trials.[comment]. American Heart Journal. 2002, 144: 981-986. 10.1067\/mhj.2002.124048.","journal-title":"American Heart Journal"},{"key":"77_CR20","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1111\/j.1553-2712.2002.tb02190.x","volume":"9","author":"AF Manini","year":"2002","unstructured":"Manini AF, Gisondi MA, van V, Schreiber DH: Adverse cardiac events in emergency department patients with chest pain six months after a negative inpatient evaluation for acute coronary syndrome. Academic Emergency Medicine. 2002, 9: 896-902. 10.1197\/aemj.9.9.896.","journal-title":"Academic Emergency Medicine"},{"key":"77_CR21","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/S0196-0644(97)70317-2","volume":"29","author":"JL Tatum","year":"1997","unstructured":"Tatum JL, Jesse RL, Kontos MC, Nicholson CS, Schmidt KL, Roberts CS, Ornato JP: Comprehensive strategy for the evaluation and triage of the chest pain patient. Ann Emerg Med. 1997, 29: 116-125.","journal-title":"Ann Emerg Med"},{"key":"77_CR22","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1016\/S0002-9149(00)00916-4","volume":"86","author":"DB Diercks","year":"2000","unstructured":"Diercks DB, Gibler WB, Liu T, Sayre MR, Storrow AB: Identification of patients at risk by graded exercise testing in an emergency department chest pain center. American Journal of Cardiology. 2000, 86: 289-292. 10.1016\/S0002-9149(00)00916-4.","journal-title":"American Journal of Cardiology"},{"key":"77_CR23","doi-asserted-by":"publisher","first-page":"1832","DOI":"10.1161\/01.CIR.103.14.1832","volume":"103","author":"LK Newby","year":"2001","unstructured":"Newby LK, Storrow AB, Gibler WB, Garvey JL, Tucker JF, Kaplan AL, Schreiber DH, Tuttle RH, McNulty SE, Ohman EM: Bedside multimarker testing for risk stratification in chest pain units: The chest pain evaluation by creatine kinase-MB, myoglobin, and troponin I (CHECKMATE) study.[comment]. Circulation. 2001, 103: 1832-1837.","journal-title":"Circulation"},{"key":"77_CR24","doi-asserted-by":"publisher","first-page":"996","DOI":"10.7326\/0003-4819-127-11-199712010-00009","volume":"127","author":"G Nichol","year":"1997","unstructured":"Nichol G, Walls R, Goldman L, Pearson S, Hartley LH, Antman E, Stockman M, Teich JM, Cannon CP, Johnson PA, Kuntz KM, Lee TH: A critical pathway for management of patients with acute chest pain who are at low risk for myocardial ischemia: recommendations and potential impact.[comment]. Annals of Internal Medicine. 1997, 127: 996-1005.","journal-title":"Annals of Internal Medicine"},{"key":"77_CR25","doi-asserted-by":"publisher","first-page":"1882","DOI":"10.1056\/NEJM199812243392603","volume":"339","author":"ME Farkouh","year":"1998","unstructured":"Farkouh ME, Smars PA, Reeder GS, Zinsmeister AR, Evans RW, Meloy TD, Kopecky SL, Allen M, Allison TG, Gibbons RJ, Gabriel SE: A clinical trial of a chest-pain observation unit for patients with unstable angina. Chest Pain Evaluation in the Emergency Room (CHEER) Investigators.[comment]. New England Journal of Medicine. 1998, 339: 1882-1888. 10.1056\/NEJM199812243392603.","journal-title":"New England Journal of Medicine"},{"key":"77_CR26","first-page":"28","volume-title":"Statistics With Confidence","author":"MJ Gardner","year":"1989","unstructured":"Gardner MJ, Altman PG: Calculating confidence intervals for proportions and their differences. Statistics With Confidence. 1989, London, British Medical Journal, 28-33. 1","edition":"1"},{"key":"77_CR27","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/S0002-9149(97)00422-0","volume":"80","author":"LG Graff","year":"1997","unstructured":"Graff LG, Dallara J, Ross MA, Joseph AJ, Itzcovitz J, Andelman RP, Emerman C, Turbiner S, Espinosa JA, Severance H: Impact on the care of the emergency department chest pain patient from the chest pain evaluation registry (CHEPER) study. American Journal of Cardiology. 1997, 80: 563-568. 10.1016\/S0002-9149(97)00422-0.","journal-title":"American Journal of Cardiology"},{"key":"77_CR28","doi-asserted-by":"publisher","first-page":"e111","DOI":"10.1161\/01.CIR.0000070982.94049.A2","volume":"107","author":"RA Lange","year":"2003","unstructured":"Lange RA, Hillis LD: Cardiology patient pages. Diagnostic cardiac catheterization. Circulation. 2003, 107: e111-e113. 10.1161\/01.CIR.0000070982.94049.A2.","journal-title":"Circulation"},{"key":"77_CR29","doi-asserted-by":"publisher","first-page":"2313","DOI":"10.1001\/jama.282.24.2313","volume":"282","author":"CH Braddock","year":"1999","unstructured":"Braddock CH, Edwards KA, Hasenberg NM, Laidley TL, Levinson W: Informed decision making in outpatient practice: time to get back to basics.[comment]. JAMA. 1999, 282: 2313-2320. 10.1001\/jama.282.24.2313.","journal-title":"JAMA"},{"key":"77_CR30","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1067\/mem.2002.122705","volume":"39","author":"WG Baxt","year":"2002","unstructured":"Baxt WG, Shofer FS, Sites FD, Hollander JE: A neural computational aid to the diagnosis of acute myocardial infarction. Ann Emerg Med. 2002, 39: 366-373. 10.1067\/mem.2002.122705.","journal-title":"Ann Emerg Med"}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1472-6947-5-26.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/1472-6947-5-26\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1472-6947-5-26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1472-6947-5-26.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T01:47:35Z","timestamp":1630460855000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/1472-6947-5-26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,8,11]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2005,12]]}},"alternative-id":["77"],"URL":"https:\/\/doi.org\/10.1186\/1472-6947-5-26","relation":{},"ISSN":["1472-6947"],"issn-type":[{"value":"1472-6947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2005,8,11]]},"assertion":[{"value":"4 January 2005","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 August 2005","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 August 2005","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"26"}}