A systematic review and evaluation of the scientific literature related to these technologies was undertaken based on Medline and related electronic literature searches and supplemented by the scientists' understanding of the literature and ongoing research. Relevant English literature on each technology was reviewed, summarized, and analyzed. For each technology, studies were formally evaluated and then rated. The quality of evidence provided by the relevant studies was rated as A, B, C, or NK as follows: A (least bias), prospective controlled clinical trials of high quality (e.g., large randomized controlled trials ); B (susceptible to some bias), substantial clinical studies (e.g., prospective cohort studies); C (likely to have significant bias), limited studies or evidence (e.g., case series, small clinical studies); or NK, not known (e.g., expert opinion or case reports only).
Based on these reviews, each technology, for its primary purpose, was rated in terms of its diagnostic performance for identifying ACI/AMI in actual use and its demonstrated clinical impact. Diagnostic performance indicates the accuracy of the technology and is measured by sensitivity, specificity, or receiver-operating characteristic curve, for ACI or AMI. Clinical impact indicates its demonstrated impact on diagnosis, triage, treatment, or outcome (e.g., mortality) when used by clinicians in actual practice. Performance in each of these two dimensions was rated as: + + + (very accurate diagnosis/large clinical impact), ++ (moderately accurate/medium impact), + (modestly accurate/small impact), NK (not known), or NE (not effective). When there were suffi cient numbers of studies available for a specific technology, a meta-analysis was performed to quantify diagnostic performance or clinical impact.
In assigning these ratings, each technology was evaluated on the basis of its performance of its primary diagnostic purpose of general ED detection (G), early detection (E), and detection in specific subgroup (S). These designations are noted in Table 14, which appears at the end of this summary.
The Systematic Review's conclusions and ratings for each diagnostic technology follow. The ratings of the Systemic Review reflect its estimation of the accuracy or impact of the test in actual practice in the ED. These assessments incorporate the quality of the literature, the magnitude or effect size of the reported findings, and considerations of generalizability and feasibility.
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