Decision support for the initial triage of patients with acute coronary syndromes.

Early revascularization of acute coronary syndromes improves the prognosis. It is of vital importance that the decision to treat the patient is taken as early as possible. The aim of this study was (i) to develop an automated tool for the analysis of electrocardiograms (ECGs) with regard to changes that indicate possible transmural ischaemia and (ii) to assess the influence of the tool on the ECG classifications of three interns with less than 12 months of experience in ECG reading. An artificial neural network was trained to automatically interpret ECGs using 3000 ECGs recorded at an emergency department. Thereafter, the performance of the network was evaluated using 1000 test ECGs. In the second step, three interns classified these test ECGs twice on different occasions, with and without the advice of the neural network. The gold standard was the classification made by two experienced cardiologists. On average, the three interns showed a sensitivity of 68% at a specificity of 92% without the advice of the neural network and a sensitivity of 93% at a specificity of 87% with the advice. The neural network itself showed a sensitivity of 95% at a specificity of 88%. The increase in sensitivity of 23-26% was significant (P<0.001) for all three interns. In conclusion, an artificial neural network can be trained to the improve performance in the interpretation of ST-segment changes in accordance with that of the experienced cardiologists.

[New service for laboratory investigation of problematic cases. Four patients illustrate the value of EQUALIS]. / Ny möjlighet till laboratorieutredning av oklara fall. Fyra patientfall illustrerar värdet av EQUALIS.

In 1996, the Endocrinology Group in EQUALIS, in collaboration with The Thyroid Unit at The Section of Endocrinology at Sahlgrenska University Hospital, introduced a "patient-related" quality assurance program. Serum samples from patients with established or suspected thyroid disorder and/or results from thyroid-related biochemical measurements which were at variance with the clinical presentation, were analyzed by the participants of an external quality assurance program in endocrinology. The results from this program were informative as regards capacity, in the individual laboratories, for the evaluation of analytical and/or biological factors causing unexpected results from the measurement of thyroid-related serum components. We now present four clinical cases, which had offered diagnostic problems. EQUALIS, in collaboration with the participants of the external quality assurance program in endocrinology and on the basis of experiences from this program, now offers a diagnostic service for clinical chemistry laboratories and physicians when they are confronted with unexpected results from the immunochemical measurement of analytes included in the program.