Systematic review of clinical decision support systems for pre-hospital acute coronary syndrome identification

Charles Knoery, Janet Heaton, Rob Polson, RR Bond, Aleeha Iftikhar, Khaled Rjoob, V. E. McGilligan, Aaron Peace, Stephen Leslie

Research output: Contribution to journalReview articlepeer-review

7 Citations (Scopus)
340 Downloads (Pure)


OBJECTIVES: Timely prehospital diagnosis and treatment of acute coronary syndrome (ACS) are required to achieve optimal outcomes. Clinical decision support systems (CDSS) are platforms designed to integrate multiple data and can aid with management decisions in the prehospital environment. The review aim was to describe the accuracy of CDSS and individual components in the prehospital ACS management. METHODS: This systematic review examined the current literature regarding the accuracy of CDSS for ACS in the prehospital setting, the influence of computer-aided decision-making and of 4 components: electrocardiogram, biomarkers, patient history, and examination findings. The impact of these components on sensitivity, specificity, and positive and negative predictive values was assessed. RESULTS: A total of 11,439 articles were identified from a search of databases, of which 199 were screened against the eligibility criteria. Eight studies were found to meet the eligibility and quality criteria. There was marked heterogeneity between studies which precluded formal meta-analysis. However, individual components analysis found that patient history led to significant improvement in the sensitivity and negative predictive values. CDSS which incorporated all 4 components tended to show higher sensitivities and negative predictive values. CDSS incorporating computer-aided electrocardiogram diagnosis showed higher specificities and positive predictive values. CONCLUSIONS: Although heterogeneity precluded meta-analysis, this review emphasizes the potential of ACS CDSS in prehospital environments that incorporate patient history in addition to integration of multiple components. The higher sensitivity of certain components, along with higher specificity of computer-aided decision-making, highlights the opportunity for developing an integrated algorithm with computer-aided decision support.

Original languageEnglish
Pages (from-to)119-125
Number of pages7
JournalCritical Pathways in Cardiology
Issue number3
Early online date11 Mar 2020
Publication statusPublished (in print/issue) - 1 Sept 2020

Bibliographical note

Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.

Copyright 2020 Elsevier B.V., All rights reserved.


  • acute coronary syndrome
  • algorithm
  • clinical decision support systems
  • diagnosis
  • emergency medical services


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