Male in his 40’s with chest pressure: what is the diagnosis
This 40-some year old patient complained of chest pressure and had this ECG recorded: See comments and diagnosis below The providers were a…
Home Modified Sgarbossa Rule Published Online: Annals of Emergency Medicine
onSeptember 4, 2012
Can you clarify the simple rule that you mention in the last paragraph. What is the ratio you are using? Is it the ST/S ratio?
Yes, it is the ST/S ration whether the ST segment is elevated or depressed, but always discordant to the predominant part of the QRS. That is, excessively discordant ST depression OR excessively discordant ST elevation.
I have read this full text,
I have a question ,How to calculate prevalence for relate pretest and post test probability in this study?
Are you have likelihood ratio nomogram?
Thank you
Good question. The exact pretest prob of coronary occlusion in patients presenting to the ED with chest pain and/or SOB is uncertain, but is probably about 2-3%. Therefore, a positive modified Sgarbossa criteria would still have a low post test probability, but the consequences of missing the diagnosis are severe, so a false + is not so bad. The post test prob of a negative mod Sgarbossa would be incredibly low and all but rule out occlusion
Steve Smith
thank you very much for you answer
but I'm sorry to bother you again , I can't find a 2 by 2 table in this full text for calculate sensitivity,specitivity,LR+,LR- by myself
could you please tell me about how to computation 2 by 2 table from data in this journal.Or are you have more data for calculate 2 by 2 table?
thank in advance.
With out using a nomogram , the ST/S,R ratio is directly infered from the previous Sgarbossa ECG criteria for LBBB and STEME .
not sure what you mean here, either
There is not a 2 x 2 table, but all the necessary data can be found in Table 2 if you dig a little.
Steve Smith
Hello Dr. Smith,
When you say LBBB does this include pacemakers? The paper did not mention this patient population.
Salim
Salim
Salim, we did not study patients with paced rhythm. There are two previous papers on use of sgarbossa criteria in paced rhythm, but both with very few cases. I nevertheless think it is safe to treat paced rhythm like LBBB and have few cases here on my blog which illustrate STEMI in paced rhythm.
Steve
I my own personal opinion , the paced rhythm is similarly to the LBBB , moreover ,the chest pain and biomarkers are additional diagnostic information .
Does the modified rule has 2 point also ? If so its only total less than 3 points if we use Sgarbossa Criteria ? so what the next step if either modified or Sgarbosa criteria give only 2 points ?
Modified Sgarbossa does NOT use points. It is "UNWEIGHTED".
Better to use the pure percentage rather than negative 0.25 , better to say more than 0.25 or equal or more than 0.30 .
not sure what you mean
Sir, I don't understand why the ratio 0.3 is more sensitive (100%) than 0.25, while the ratio 0.2 is more sensitive than 0.25, too. Is it a mistake?
it was more sensitive because it included discordant ST depression as well, not just ST elevation. In our validation study, that criterion did not turn out to be as sensitive, though it was very specific.