RT Journal Article
SR Electronic
T1 Accuracy of symptoms and signs for coronary heart disease assessed in primary care
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e246
OP e257
DO 10.3399/bjgp10X502137
VO 60
IS 575
A1 Stefan Bösner
A1 Annette Becker
A1 Maren Abu Hani
A1 Heidi Keller
A1 Andreas C Sönnichsen
A1 Jörg Haasenritter
A1 Konstantinos Karatolios
A1 Juergen R Schaefer
A1 Erika Baum
A1 Norbert Donner-Banzhoff
YR 2010
UL http://bjgp.org/content/60/575/e246.abstract
AB Background Diagnosing the aetiology of chest pain is challenging. There is still a lack of data on the diagnostic accuracy of signs and symptoms for acute coronary events in low-prevalence settings.Aim To evaluate the diagnostic accuracy of symptoms and signs in patients presenting to general practice with chest pain.Design of study Cross-sectional diagnostic study with delayed-type reference standard.Setting Seventy-four general practices in Germany.Method The study included 1249 consecutive patients presenting with chest pain. Data were reviewed by an independent reference panel, with coronary heart disease (CHD) and an indication for urgent hospital admission as reference conditions. Main outcome measures were sensitivity, specificity, likelihood ratio, predictive value, and odds ratio (OR) for non-trauma patients with a reference diagnosis.Results Several signs and symptoms showed strong associations with CHD, including known vascular disease (OR = 5.13; 95% confidence interval [CI] = 2.83 to 9.30), pain worse on exercise (OR = 4.27; 95% CI = 2.31 to 7.88), patient assumes cardiac origin of pain (OR = 3.20; 95% CI = 1.53 to 6.60), cough present (OR = 0.08; 95% CI = 0.01 to 0.77), and pain reproducible on palpation (OR = 0.27; 95% CI = 0.13 to 0.56). For urgent hospital admission, effective criteria included pain radiating to the left arm (OR = 8.81; 95% CI = 2.58 to 30.05), known clinical vascular disease (OR = 7.50; 95% CI = 2.88 to 19.55), home visit requested (OR = 7.31; 95% CI = 2.27 to 23.57), and known heart failure (OR = 3.53; 95% CI = 1.14 to 10.96).Conclusion Although individual criteria were only moderately effective, in combination they can help to decide about further management of patients with chest pain in primary care.