英国基层心脏介入中心非工作时间急性心脏病服务质量评估
本研究为英国一家地区综合医院开展的回顾性单中心服务评估，纳入2025年1月至6月共233例非工作时间就诊患者，比较心脏外展执业者初步诊断与出院诊断的一致性。结果显示总体完全诊断一致率为92.7%，识别急性冠脉综合征的灵敏度为96.0%、特异度为92.4%，Cohen's κ为0.858，提示心脏外展执业者评估可靠。
要点
- 心脏外展执业者初步诊断与出院诊断总体完全一致率达92.7%。
- 识别ACS的灵敏度为96.0%，阴性预测值为98.0%。
- 17例不一致病例均未导致延迟升级、检查或处理。
核心结论
- 心脏外展执业者初步诊断与心内科顾问医生出院诊断相比显示出较高的完全诊断一致性。
- 这一新证据提示心脏外展执业者主导的评估在临床路径内是可靠的。
研究设计与样本
- 回顾性单中心服务评估，在英国一家地区综合医院开展，时间为2025年1月至6月。
- 共筛选779例病例，经逐步排除后233例患者符合纳入标准。
主要发现
- 总体完全诊断一致率为92.7%（216/233），其中心脏诊断一致125例，非心脏诊断一致91例。
- 17例诊断不一致，但均未导致延迟升级、检查或处理。
- 识别ACS的灵敏度为96.0%，特异度为92.4%，阳性预测值为85.9%，阴性预测值为98.0%，总体分类准确率为93.6%。
- Cohen's κ为0.858（95% CI 0.789至0.927），提示几乎完全一致。
临床怎么用
- 心内科智能体可参考心脏外展执业者在非工作时间初诊路径中具备较高的诊断可靠性，可用于风险分层和ACS排查。
- 对于ACS阴性预测值较高的情况，可辅助支持低风险患者的初步分流，但仍需结合心内科顾问医生最终确认。
局限性
- 该研究为单中心回顾性服务评估，结果可能受本地流程和人员经验影响。
- 原文未报告随访期间更远期临床结局，无法评价不一致病例对预后的影响。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Background Many district general hospitals (DGHs) in the UK do not have resident on-call cardiology registrars overnight; in these situations, it is becoming more common for cardiac outreach practitioners (COPs) to provide specialist input for patients presenting with suspected cardiac events. The aim of this study is to evaluate the exact diagnostic concordance between the initial working diagnoses made independently by COPs and subsequent final discharge diagnoses in patients assessed out of hours and to assess the accuracy of identifying acute coronary syndrome (ACS). Methods A retrospective, single-centre service evaluation was conducted at a UK DGH between January and June 2025. Initial COP diagnoses were compared with final discharge diagnoses, with exact diagnostic concordance reported as percentage agreement. Diagnostic performance for identifying ACS was assessed using sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy and Cohen’s kappa (). Results A total of 779 cases were screened, with 233 patients meeting inclusion criteria following staged exclusions. The overall exact diagnostic concordance was 92.7% (216/233). The 216 exact concordant cases comprised 125 concordant cardiac diagnoses and 91 concordant non-cardiac diagnoses. 17 cases had discordant diagnoses, but none were associated with delayed escalation, investigation or management. COP sensitivity for identifying ACS was 96.0%, specificity was 92.4%, positive predictive value was 85.9%, negative predictive value was 98.0% and overall classification accuracy was 93.6%. Cohen’s was 0.858 (95% CI 0.789 to 0.927), indicating almost-perfect agreement. Conclusion COPs demonstrated a high level of exact diagnostic concordance when compared with discharge diagnosis made by consultant cardiologist. This new evidence suggests that COP-led assessments are reliable when working within a clinical pathway.
引用
- Open Heart：Maintaining quality out-of-hours in an acute cardiology service in a UK primary PCI centre
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。