TY - JOUR T1 - The case of ‘protective fever and chest signs’: towards a better understanding of general practice databases JF - British Journal of General Practice JO - Br J Gen Pract SP - 523 LP - 525 VL - 57 IS - 540 AU - Chris van Weel Y1 - 2007/07/01 UR - http://bjgp.org/content/57/540/523.abstract N2 - General practice databases provide researchers with information about the realities of primary care. Empirical data of GPs' care of patients is a key resource in primary care research,1 and it is a positive sign that this trend is increasing in the worldwide health science community. In a number of countries, robust general practice databases are emerging which serve as an infrastructure for studies of diagnosis, prognosis, and management of health problems. An inherent strength of the databases are their strong links to the community in which the GPs practice and, as a consequence, they enable direct research of important health problems.2 Although GP databases are relevant to large sectors of the science and healthcare communities, they can be difficult to interpret.This month's edition of the BJGP presents five studies on diagnostic acuity of serious (respiratory tract) infections in the general practice population (Hay et al3, Van den Bruel et al,4 Holm et al,5,6 and van Duijn et al7). The studies examining different populations report a generally low a priori probability of serious disease — well below 1%. All studies analyse infectious signs and symptoms, while the value of additional testing of inflammatory markers is reported by Holm et al, for C-reactive protein and procalcitonin.5,6 A general finding was that signs, symptoms, and additional testing were related to diagnostic outcome. However, construction of a robust algorithm was only possible for ruling out serious disease, not for identifying it.A problem with ruling out rather than diagnosing serious disease is that signs and symptoms seldom enter the surgery in their own right: patients' beliefs and expectations interact in their presentation of illness, and determine as van Duijn et al,7 report, diagnostic and therapeutic outcome. Additionally, GPs … ER -