Chest pain in general practice: a systematic review of prediction rules

BMJ Open
Ralf E HarskampHenk C P M van Weert

Abstract

To identify and assess the performance of clinical decision rules (CDR) for chest pain in general practice. Systematic review of diagnostic studies. Medline/Pubmed, Embase/Ovid, CINAHL/EBSCO and Google Scholar up to October 2018. Studies that assessed CDRs for intermittent-type chest pain and for rule out of acute coronary syndrome (ACS) applicable in general practice, thus not relying on advanced laboratory, computer or diagnostic testing. Reviewers identified studies, extracted data and assessed the quality of the evidence (using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2)), independently and in duplicate. Eight studies comprising five CDRs met the inclusion criteria. Three CDRs are designed for rule out of coronary disease in intermittent-type chest pain (Gencer rule, Marburg Heart Score, INTERCHEST), and two for rule out of ACS (Grijseels rule, Bruins Slot rule). Studies that examined the Marburg Heart Score had the highest methodological quality with consistent sensitivity (86%-91%), specificity (61%-81%) and positive (23%-35%) and negative (97%-98%) predictive values (PPV and NPV). The diagnostic performance of Gencer (PPV: 20%-34%, NPV: 95%-99%) and INTERCHEST (PPV: 35%-43%, NPV: 96%-98%) appear comparab...Continue Reading

References

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Citations

Jan 7, 2021·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·R E HarskampW A M Lucassen

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Software Mentioned

QUADAS
INTERCHEST
Google Scholar
Review Manager ( RevMan
Quality Assessment of Diagnostic Accuracy Studies ( QUADAS - 2 )

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