This comical, fundamentally flawed publication has already been skewered online in just the handful of days since it hit publication. But, any press is good press, right?<\/p>\n
We’ve been practicing under the prevailing notion women more frequently manifest atypical constellations of symptoms when presenting with acute myocardial infarction. We’ve inferred this from observational cohort data, and from studies indicating we miss more diagnoses of AMI in women. So, these authors set to prospectively validate this notion.<\/p>\n
It’s rather sad, unfortunately, how much effort and time was spent prospectively enrolling the 2,475 patients recruited for this study. Each patient underwent a structured clinical interview to determine the presence or absence of specific chest pain features, and these were correlated with final adjucated diagnosis of AMI. And, in the end, the positive and negative likelihood ratios for AMI for nearly every recorded feature were identical for men and women.<\/p>\n
But, when you exclusively enroll patients with “symptoms suggestive of AMI”, you’ve designed precisely the type of study that will never detect atypical presentations of AMI. If clinicians didn’t suspect acute coronary syndrome associated with an episode of chest pain, these patients are discarded from follow-up. Unfortunately, then, this work is unable to conclusively answer any question regarding gender-specific symptoms.<\/p>\n
To truly evaluate this question, the inclusion criteria would have be far more expansive. Essentially, nearly all atraumatic patients with a somatic complaint above the pelvis should be screened and followed for a definitive diagnosis of AMI. Perhaps that study would be too large and unwieldy to successfully execute, but that would be the scope required to answer this question once and for all (within the bounds of external validity).<\/p>\n
Finally, I just want to point back to Seth Trueger’s write-up<\/a> of a lovely ED chest pain study, where expert rheumatologists made gold standard diagnoses of costochondritis in the Emergency Department. Incidence of AMI in “costochondritis” patients? 6%.<\/p>\n “Sex-Specific Chest Pain Characteristics in the Early Diagnosis of Acute Myocardial Infarction” This comical, fundamentally flawed publication has already been skewered online in just the handful of days since it hit publication. But, any press is good press, right? We’ve been practicing under the prevailing notion women more frequently manifest atypical constellations of symptoms when presenting with acute myocardial infarction. We’ve inferred this from observational cohort data, … Continue reading “Gender-Specific Symptom Nonsense”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[6,7],"tags":[],"class_list":["post-444","post","type-post","status-publish","format-standard","hentry","category-cardiology","category-chest-pain"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7KesJ-7a","jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts\/444","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=444"}],"version-history":[{"count":1,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts\/444\/revisions"}],"predecessor-version":[{"id":2005,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts\/444\/revisions\/2005"}],"wp:attachment":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=444"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=444"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=444"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=1783306<\/a><\/p>\n\n