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Forschungsdatenbank PMU-SQQUID

Accuracy of symptoms and signs for coronary heart disease assessed in primary care.
Bösner, S; Becker, A; Abu Hani, M; Keller, H; Sönnichsen, AC; Haasenritter, J; Karatolios, K; Schaefer, JR; Baum, E; Donner-Banzhoff, N;
Br J Gen Pract. 2010; 60(575): e246-e257.
Originalarbeiten (Zeitschrift)

PMU-Autor/inn/en

Sönnichsen Andreas

Abstract

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.
To evaluate the diagnostic accuracy of symptoms and signs in patients presenting to general practice with chest pain.
Cross-sectional diagnostic study with delayed-type reference standard.
Seventy-four general practices in Germany.
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.
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).
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.


Useful keywords (using NLM MeSH Indexing)

Adult

Aged

Aged, 80 and over

Chest Pain/epidemiology

Chest Pain/etiology*

Coronary Disease/complications

Coronary Disease/diagnosis*

Coronary Disease/epidemiology

Epidemiologic Methods

Family Practice*

Female

Germany/epidemiology

Humans

Male

Medical History Taking

Middle Aged

Reference Standards


Find related publications in this database (Keywords)

chest pain
medical history taking
myocardial ischaemia
primary health care
sensitivity and specificity