Clinical Uncertainty, Diagnostic Accuracy, and Outcomes in Emergency Department Patients Presenting With Dyspnea

Results: Clinical uncertainty was present in 185 patients (31%), 103 (56%) of whom had ADHF. Patients judgedwithclinicaluncertaintyhadlongerhospitallength of stay and increased morbidity and mortality, especially those with ADHF. Receiver operating characteristic analysis of clinical judgment yielded an area under the curve (AUC) of 0.88 in the clinical certainty group and 0.76 in the uncertainty group (P.001); NTproBNP testing alone in these same groups had AUCs of 0.96 and 0.91, respectively. The combination of clinical judgment with NT-proBNP testing yielded improvements in AUC. Conclusions:Among dyspneic patients in the ED, clinicaluncertaintyisassociatedwithincreasedmorbidityand mortality, especially in those with ADHF. The addition of NT-proBNP testing to clinical judgment may reduce diagnostic uncertainty in this setting. Arch Intern Med. 2008;168(7):741-748