Predictive ability of an early diagnostic guess in patients presenting with chest pain; a longitudinal descriptive study

BMC Family Practice

Research Article

Bernard Burnand¹  Alain Pécoud²  Bernard Favrat²  François Verdon³  Paul Vaucher³  Michel Junod³  Thomas Bischoff³  Lilli Herzig³ 

[1] Clinical Epidemiology Centre, Institute of Social and Preventive Medicine, Hospices-CHUV and Faculty of Biology and Medicine, University of Lausanne, Bugnon 21, 1011, Lausanne, Switzerland;Department of Ambulatory Care and Community Medicine, Bugnon 44, 1011, Lausanne, Switzerland;Institute of General Medicine, University of Lausanne, Bugnon 44, 1011, Lausanne, Switzerland;

关键词: General Practitioner;    Chest Pain;    Predictive Ability;    Final Diagnosis;    Life Threatening Illness;   

DOI  :  10.1186/1471-2296-11-14

 received in 2009-03-19, accepted in 2010-02-21,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundThe intuitive early diagnostic guess could play an important role in reaching a final diagnosis. However, no study to date has attempted to quantify the importance of general practitioners' (GPs) ability to correctly appraise the origin of chest pain within the first minutes of an encounter.MethodsThe validation study was nested in a multicentre cohort study with a one year follow-up and included 626 successive patients who presented with chest pain and were attended by 58 GPs in Western Switzerland. The early diagnostic guess was assessed prior to a patient's history being taken by a GP and was then compared to a diagnosis of chest pain observed over the next year.ResultsUsing summary measures clustered at the GP's level, the early diagnostic guess was confirmed by further investigation in 51.0% (CI 95%; 49.4% to 52.5%) of patients presenting with chest pain. The early diagnostic guess was more accurate in patients with a life threatening illness (65.4%; CI 95% 64.5% to 66.3%) and in patients who did not feel anxious (62.9%; CI 95% 62.5% to 63.3%). The predictive abilities of an early diagnostic guess were consistent among GPs.ConclusionsThe GPs early diagnostic guess was correct in one out of two patients presenting with chest pain. The probability of a correct guess was higher in patients with a life-threatening illness and in patients not feeling anxious about their pain.

【 授权许可】

Unknown   
© Verdon et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.