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Steve Goodacre

Publications and source records attributed to Steve Goodacre.

6 recordsLinked to original sources
PubMed2004

Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care.

OBJECTIVES: To measure the effectiveness and cost effectiveness of providing care in a chest pain observation unit compared with routine care for patients with acute, undifferentiated chest pain. DESIGN: Cluster randomised controlled trial, with 442 days randomised to the chest pain observation unit or routine care, and cost effectiveness analysis from a health service costing perspective. SETTING: The emergency department at the Northern General Hospital, Sheffield, United Kingdom. PARTICIPANTS: 972 patients with acute, undifferentiated chest pain (479 attending on days when care was delivered in the chest pain observation unit, 493 on days of routine care) followed up until six months after initial attendance. MAIN OUTCOME MEASURES: The proportion of participants admitted to hospital, the proportion with acute coronary syndrome sent home inappropriately, major adverse cardiac events over six months, health utility, hospital reattendance and readmission, and costs per patient to the health service. RESULTS: Use of a chest pain observation unit reduced the proportion of patients admitted from 54% to 37% (difference 17%, odds ratio 0.50, 95% confidence interval 0.39 to 0.65, P < 0.001) and the proportion discharged with acute coronary syndrome from 14% to 6% (8%, -7% to 23%, P = 0.264). Rates of cardiac event were unchanged. Care in the chest pain observation unit was associated with improved health utility during follow up (0.0137 quality adjusted life years gained, 95% confidence interval 0.0030 to 0.0254, P = 0.022) and a saving of pound 78 per patient (- pound 56 to pound 210, P = 0.252). CONCLUSIONS: Care in a chest pain observation unit can improve outcomes and may reduce costs to the health service. It seems to be more effective and more cost effective than routine care.

Algorithms↗
PubMed2003

Research methods: beyond the clinical trial.

Emergency medicine differs from other specialties in that it has few restrictions in terms of pathology or patient group but is instead defined by time, with patients being selected on the basis of urgency. The important research questions generated by emergency medicine are therefore often complex and relate to organizational, economic, or social issues. Clinical trials have a limited role to play in these circumstances, and concepts such as the hierarchy of evidence might be unhelpful if the best methodology is not appropriate to the research question. Emergency medicine researchers therefore need to be prepared to use a wide range of methods, often in combination and often drawing on the social sciences. This article will introduce readers to methods from clinical epidemiology, operational research, health economics, and qualitative research, discussing the value of these approaches and identifying potential pitfalls.

Cluster Analysis↗
PubMed2002

How useful are clinical features in the diagnosis of acute, undifferentiated chest pain?

OBJECTIVES: To measure the predictive value and diagnostic performance of clinical features used to diagnose coronary syndromes in patients presenting with acute, undifferentiated chest pain. METHODS: The clinical features of patients presenting to the authors' chest pain unit with acute, undifferentiated chest pain were prospectively recorded on a standard form. Admitted patients were followed up by case note review. Discharged patients were followed up as outpatients three days later. Six months after the emergency department visit, evidence of adverse events was searched for from the hospital computer database, case notes, and the patient's primary care physician. The authors tested the power of each feature to predict: 1) acute myocardial infarction (AMI) by World Health Organization criteria, and 2) any acute coronary syndrome (ACS), evidenced by cardiac testing, AMI, arrhythmia, death, or revascularization procedure within six months. RESULTS: Eight hundred ninety-three patients were assessed, 34 (3.8%) with AMI and 81 (9.1%) with ACS. Features useful in the diagnosis of AMI were exertional pain [likelihood ratio (LR) = 2.35], pain radiating to the shoulder or both arms (LR = 4.07), and chest wall tenderness (LR = 0.3). Features useful in the diagnosis of ACS were exertional pain (LR = 2.06) and pain radiating to the shoulder, the left arm, or both arms (LR = 1.62). The site or nature of pain and the presence of nausea, vomiting, or diaphoresis were not predictive of AMI or ACS. CONCLUSIONS: Important differences exist when clinical features are specifically investigated in patients with acute chest pain and a nondiagnostic electrocardiogram. Clinical features have a limited role to play in triage decision making.

Acute Disease↗