Coronary heart disease in primary care: accuracy of medical history and physical findings in patients with chest pain – a study protocol for a systematic review with individual patient data

BMC Family Practice

Study Protocol

Walter Renier¹  Frank Buntinx²  J André Knottnerus³  Norbert Donner-Banzhoff⁴  Jörg Haasenritter⁴  Stefan Bösner⁴  Staffan Nilsson⁵  Lilli Herzig⁶  Bernard Burnand⁷  Harold Sox⁸  Carol Sox⁸  Girma Minalu⁹  Marc Aerts⁹ 

[1] Department of General Practice, Katholieke Universities Leuven, Leuven, Belgium;Department of General Practice, Katholieke Universities Leuven, Leuven, Belgium;Department of General Practice, University of Maastricht, Maastricht, The Netherlands;Department of General Practice, University of Maastricht, Maastricht, The Netherlands;Department of General Practice/ Family Medicine, University of Marburg, D-35032, Marburg, Germany;Department of Medical and Health Sciences, General Practice, Linköping University, Linköping, Sweden;Institute of General Medicine, University of Lausanne, Lausanne, Switzerland;Lausanne University Hospital, Lausanne, Switzerland;The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, USA;Universities of Leuven and Hasselt, Interuniversity Institute for Biostatistics and Bioinformatics, Leuven, Belgium;

关键词: MeSH;    Chest pain;    Myocardial ischemia;    Medical history taking;    Sensitivity and specificity;    Primary health care;   

DOI  :  10.1186/1471-2296-13-81

 received in 2011-02-28, accepted in 2012-07-27,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundChest pain is a common complaint in primary care, with coronary heart disease (CHD) being the most concerning of many potential causes. Systematic reviews on the sensitivity and specificity of symptoms and signs summarize the evidence about which of them are most useful in making a diagnosis. Previous meta-analyses are dominated by studies of patients referred to specialists. Moreover, as the analysis is typically based on study-level data, the statistical analyses in these reviews are limited while meta-analyses based on individual patient data can provide additional information. Our patient-level meta-analysis has three unique aims. First, we strive to determine the diagnostic accuracy of symptoms and signs for myocardial ischemia in primary care. Second, we investigate associations between study- or patient-level characteristics and measures of diagnostic accuracy. Third, we aim to validate existing clinical prediction rules for diagnosing myocardial ischemia in primary care. This article describes the methods of our study and six prospective studies of primary care patients with chest pain. Later articles will describe the main results.Methods/DesignWe will conduct a systematic review and IPD meta-analysis of studies evaluating the diagnostic accuracy of symptoms and signs for diagnosing coronary heart disease in primary care. We will perform bivariate analyses to determine the sensitivity, specificity and likelihood ratios of individual symptoms and signs and multivariate analyses to explore the diagnostic value of an optimal combination of all symptoms and signs based on all data of all studies. We will validate existing clinical prediction rules from each of the included studies by calculating measures of diagnostic accuracy separately by study.DiscussionOur study will face several methodological challenges. First, the number of studies will be limited. Second, the investigators of original studies defined some outcomes and predictors differently. Third, the studies did not collect the same standard clinical data set. Fourth, missing data, varying from partly missing to fully missing, will have to be dealt with.Despite these limitations, we aim to summarize the available evidence regarding the diagnostic accuracy of symptoms and signs for diagnosing CHD in patients presenting with chest pain in primary care.Review registrationCentre for Reviews and Dissemination (University of York): CRD42011001170

【 授权许可】

CC BY   
© Haasenritter et al.; licensee BioMed Central Ltd. 2012