Accuracy of emergency physicians probability estimates of acute coronary syndrome
Hemborg Kristiansson, Mia LU
; Wessman, Torgny
LU
and Ekelund, Ulf
LU
(2026)
In Diagnosis
p.1-8
- Abstract
- Objectives: Accurate risk assessment is crucial for appropriate management of patients presenting to the emergency
department (ED) with chest pain. This study aimed to evaluate how accurately emergency physicians estimate the
probability of acute coronary syndrome (ACS).
Methods: A vignette-based on a real ED chest pain patient
was presented in four sequential frames with increasing
clinical information: history and symptoms, ECG findings,
and elevated troponin levels. Evidence-based reference
probabilities of ACS were established for each frame.
Emergency physicians in the Skåne region of Sweden were
invited to estimate the probability of ACS at each stage. The
primary outcome was the difference... (More) - Objectives: Accurate risk assessment is crucial for appropriate management of patients presenting to the emergency
department (ED) with chest pain. This study aimed to evaluate how accurately emergency physicians estimate the
probability of acute coronary syndrome (ACS).
Methods: A vignette-based on a real ED chest pain patient
was presented in four sequential frames with increasing
clinical information: history and symptoms, ECG findings,
and elevated troponin levels. Evidence-based reference
probabilities of ACS were established for each frame.
Emergency physicians in the Skåne region of Sweden were
invited to estimate the probability of ACS at each stage. The
primary outcome was the difference between physicians’
estimates and the reference probabilities.
Results: Of 707 respondents, 357 physicians with recent ED
experience provided complete responses and were included
in the analysis. The median age was 34 years (IQR 30–40),
56 % were male, and slightly more than half were specialists
or senior residents. Physicians consistently overestimated
the probability of ACS across all frames. The largest
discrepancy occurred in the initial history/symptoms frame,
where the median estimated probability was approximately
70 %, compared with a reference range of 3–16 %. Although
estimation accuracy improved as additional diagnostic information was provided, estimates remained higher than
reference probabilities throughout.
Conclusions: In this realistic staged case, ED physicians
substantially overestimated the risk of ACS in chest pain
patients. Such overestimation may contribute to unnecessary diagnostic testing and overtreatment, highlighting
the need for improved training and/or decision-support tools
in emergency care.
(Less) - Abstract (Swedish)
- Abstract
Objectives
Accurate risk assessment is crucial for appropriate management of patients presenting to the emergency department (ED) with chest pain. This study aimed to evaluate how accurately emergency physicians estimate the probability of acute coronary syndrome (ACS).
Methods
A vignette-based on a real ED chest pain patient was presented in four sequential frames with increasing clinical information: history and symptoms, ECG findings, and elevated troponin levels. Evidence-based reference probabilities of ACS were established for each frame. Emergency physicians in the Skåne region of Sweden were invited to estimate the probability of ACS at each stage. The primary outcome was the difference between... (More) - Abstract
Objectives
Accurate risk assessment is crucial for appropriate management of patients presenting to the emergency department (ED) with chest pain. This study aimed to evaluate how accurately emergency physicians estimate the probability of acute coronary syndrome (ACS).
Methods
A vignette-based on a real ED chest pain patient was presented in four sequential frames with increasing clinical information: history and symptoms, ECG findings, and elevated troponin levels. Evidence-based reference probabilities of ACS were established for each frame. Emergency physicians in the Skåne region of Sweden were invited to estimate the probability of ACS at each stage. The primary outcome was the difference between physicians’ estimates and the reference probabilities.
Results
Of 707 respondents, 357 physicians with recent ED experience provided complete responses and were included in the analysis. The median age was 34 years (IQR 30–40), 56 % were male, and slightly more than half were specialists or senior residents. Physicians consistently overestimated the probability of ACS across all frames. The largest discrepancy occurred in the initial history/symptoms frame, where the median estimated probability was approximately 70 %, compared with a reference range of 3–16 %. Although estimation accuracy improved as additional diagnostic information was provided, estimates remained higher than reference probabilities throughout.
Conclusions
In this realistic staged case, ED physicians substantially overestimated the risk of ACS in chest pain patients. Such overestimation may contribute to unnecessary diagnostic testing and overtreatment, highlighting the need for improved training and/or decision-support tools in emergency care.
Keywords: probability; Bayes theorem; vignette case; chest-pain; ACS; decision-making
Introduction (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/8200edc9-2078-493e-a40f-01b0f9c0f95f
- author
- Hemborg Kristiansson, Mia
LU
; Wessman, Torgny
LU
and Ekelund, Ulf
LU
- organization
- publishing date
- 2026-07-05
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- probability; Bayes theorem; vignette case; chest-pain; ACS; decision-making
- in
- Diagnosis
- pages
- 1 - 8
- publisher
- De Gruyter Brill
- external identifiers
-
- pmid:42397268
- scopus:105043949377
- ISSN
- 2194-802X
- DOI
- 10.1515/dx-2026-0020
- language
- English
- LU publication?
- yes
- id
- 8200edc9-2078-493e-a40f-01b0f9c0f95f
- date added to LUP
- 2026-09-14 13:55:27
- date last changed
- 2026-09-15 04:00:41
@article{8200edc9-2078-493e-a40f-01b0f9c0f95f,
abstract = {{Objectives: Accurate risk assessment is crucial for appropriate management of patients presenting to the emergency<br/>department (ED) with chest pain. This study aimed to evaluate how accurately emergency physicians estimate the<br/>probability of acute coronary syndrome (ACS).<br/>Methods: A vignette-based on a real ED chest pain patient<br/>was presented in four sequential frames with increasing<br/>clinical information: history and symptoms, ECG findings,<br/>and elevated troponin levels. Evidence-based reference<br/>probabilities of ACS were established for each frame.<br/>Emergency physicians in the Skåne region of Sweden were<br/>invited to estimate the probability of ACS at each stage. The<br/>primary outcome was the difference between physicians’<br/>estimates and the reference probabilities.<br/>Results: Of 707 respondents, 357 physicians with recent ED<br/>experience provided complete responses and were included<br/>in the analysis. The median age was 34 years (IQR 30–40),<br/>56 % were male, and slightly more than half were specialists<br/>or senior residents. Physicians consistently overestimated<br/>the probability of ACS across all frames. The largest<br/>discrepancy occurred in the initial history/symptoms frame,<br/>where the median estimated probability was approximately<br/>70 %, compared with a reference range of 3–16 %. Although<br/>estimation accuracy improved as additional diagnostic information was provided, estimates remained higher than<br/>reference probabilities throughout.<br/>Conclusions: In this realistic staged case, ED physicians<br/>substantially overestimated the risk of ACS in chest pain<br/>patients. Such overestimation may contribute to unnecessary diagnostic testing and overtreatment, highlighting<br/>the need for improved training and/or decision-support tools<br/>in emergency care.<br/>}},
author = {{Hemborg Kristiansson, Mia and Wessman, Torgny and Ekelund, Ulf}},
issn = {{2194-802X}},
keywords = {{probability; Bayes theorem; vignette case; chest-pain; ACS; decision-making}},
language = {{eng}},
month = {{07}},
pages = {{1--8}},
publisher = {{De Gruyter Brill}},
series = {{Diagnosis}},
title = {{Accuracy of emergency physicians probability estimates of acute coronary syndrome}},
url = {{http://dx.doi.org/10.1515/dx-2026-0020}},
doi = {{10.1515/dx-2026-0020}},
year = {{2026}},
}