Accuracy of General Practitioners’ Assessment of Chest Pain Patients for Coronary Heart Disease in Primary Care: Cross-sectional Study with Follow-up

Bösner, Stefan; Haasenritter, Jörg; Hani, Maren Abu; Keller, Heidi; Sönnichsen, Andreas; Karatolios, Konstantinos; Schaefer, Juergen R.; Baum, Erika; Donner-Banzhoff, Norbert

doi:10.3325//cmj.2010.51.243

Cited by 13 publications

(12 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A German study not dealing with POCT-TnT found that GPs' diagnosed acute coronary syndromes with the sensitivity of only 50% and that only 41% of these patients were referred immediately to hospital [19]. This is in contrast to our study, where GPs without POCT-TnT did not fail to refer a single patient with AMI or UA.…”

Section: Discussioncontrasting

confidence: 99%

Point-of-Care Troponin T Testing in the Management of Patients with Chest Pain in the Swedish Primary Care

Nilsson

Andersson²,

Borgqúist

et al. 2013

International Journal of Family Medicine

View full text Add to dashboard Cite

Objective. To investigate the diagnostic accuracy and clinical benefit of point-of-care Troponin T testing (POCT-TnT) in the management of patients with chest pain. Design. Observational, prospective, cross-sectional study with followup. Setting. Three primary health care (PHC) centres using POCT-TnT and four PHC centres not using POCT-TnT in the southeast of Sweden. Patients. All patients ≥35 years old, contacting one of the primary health care centres for chest pain, dyspnoea on exertion, unexplained weakness, and/or fatigue with no other probable cause than cardiac, were included. Symptoms should have commenced or worsened during the last seven days. Main Outcome Measures. Emergency referrals, patients with acute myocardial infarctions (AMI), or unstable angina (UA) within 30 days of study enrolment. Results. 25% of the patients from PHC centres with POCT-TnT and 43% from PHC centres without POCT-TnT were emergently referred by the GP (P = 0.011 ). Seven patients (5.5%) from PHC centres with POCT-TnT and six (8.8%) from PHC centres without POCT-TnT were diagnosed as AMI or UA (P = 0.369). Two patients with AMI or UA from PHC centres with POCT-TnT were judged as missed cases in primary health care. Conclusion. The use of POCT-TnT may reduce emergency referrals but probably at the cost of an increased risk to miss patients with AMI or UA.

show abstract

Section: Discussioncontrasting

confidence: 99%

Point-of-Care Troponin T Testing in the Management of Patients with Chest Pain in the Swedish Primary Care

Nilsson

Andersson²,

Borgqúist

et al. 2013

International Journal of Family Medicine

View full text Add to dashboard Cite

show abstract

“…Indeed, previous research has shown that general practitioners have only moderate diagnostic accuracy when estimating the likelihood of coronary artery disease in their patients8 and the gestalt of cardiologists is unreliable for predicting findings at coronary angiography 9. However, the judgement of the treating physician has been shown to have independent diagnostic value in patients with suspected deep vein thrombosis and pulmonary embolism and is an important component of widely used clinical decision rules for those diagnoses 10 11.…”

Section: Introductionmentioning

confidence: 99%

Can emergency physicians ‘rule in’ and ‘rule out’ acute myocardial infarction with clinical judgement?

et al. 2014

View full text Add to dashboard Cite

ObjectiveTo determine the diagnostic accuracy of emergency physician gestalt in emergency department (ED) patients with suspected cardiac chest pain, both alone and in combination with initial troponin level and ECG findings.MethodsWe prospectively included patients presenting to the ED with suspected cardiac chest pain. Clinicians recorded their ‘gestalt’ at the time of presentation using a five-point Likert scale, blinded to outcome. Troponin T and high-sensitivity troponin T (hs-cTnT; both Roche Diagnostics Elecsys) levels were measured in admission blood samples. All patients underwent troponin testing at least 12 h after peak symptoms. The primary outcome was acute myocardial infarction (AMI).Results458 patients were included in this study, 81 (17.7%) of whom had AMI. Clinician gestalt alone had an area under the receiver operating characteristic curve of 0.76 (95% CI 0.70 to 0.82) for AMI. Immediately discharging patients with normal initial troponin and ECG in whom the clinician felt the diagnosis was ‘probably not’ or ‘definitely not’ acute coronary syndrome (ACS) would have avoided admission for 23.1% (95% CI 19% to 28%) patients with 100% sensitivity (95% CI 95.6% to 100%). With hs-cTnT, 100% sensitivity could have been achieved even if only patients with ‘probable’ or ‘definite’ ACS were investigated further, which would have allowed 41.7% patients to be discharged immediately.ConclusionsGestalt alone cannot be used to ‘rule in’ or ‘rule out’ ACS. By combining clinician gestalt with the admission ECG and troponin level, we found 100% sensitivity without the need for serial troponin testing. These findings have the potential to reduce unnecessary hospital admissions for suspected ACS but must be prospectively validated before considering clinical implementation.

show abstract

“…Surgeons in our study were confident that they could intuitively make decisions based on their individually accumulated clinical experience. Although surgeons prefer this method, it can lead to inaccuracies and inconsistencies such as: (1) diagnostic errors as a result of cognitive biases; (2) variations between surgeons decision‐making; (3) poor estimation of operative risk; and (4) risk of biased approaches by surgeons when assessing older adult vulnerable patients . Preoperative assessment decision‐based aids are available to minimize inaccuracy and inconsistency; however, our findings suggest a lack of incorporation of these tools into clinical practice.…”

Section: Discussionmentioning

confidence: 91%

Mechanisms of decision‐making in preoperative assessment for older adult prostate cancer patients—A qualitative study

Kierkegaard

Vale

Garrison

et al. 2019

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background and Objective: Little research exists which investigates the contextual factors and hidden influences that inform surgeons and surgical teams decisionmaking in preoperative assessment when deciding whether to or not to operate on older adult prostate cancer patients living with aging-associated functional declines and illnesses. The aim of this study is to identify and examine the underlying mechanisms that uniquely shape preoperative surgical decision-making strategies concerning older adult prostate cancer patients.Methods: Qualitative methodologies were used that paired ethnographic field observations with semistructured interviews for data collection. An inductive thematic analysis approach was used to identify, analyze, and describe patterns in the data.Results: Factors underlining surgical decision-making originated from the context of two categories: (1) clinical and surgery-specific factors; and (2) non-patient factors.Thematic subcategories included personal experiences, methods of assessment during medical encounters, anticipation of outcomes, perceptions of preoperative assessment instruments for frailty and multimorbidity, routines and workflow patterns, microcultures, and indirect observation and second-hand knowledge.Conclusion: Surgeon's personal experiences has a significant impact on the decisionmaking processes during preoperative assessments. However, non-patient factors such as institutional microcultures passively and actively influence decision-making process during preoperative assessment. K E Y W O R D S frailty, medical decision-making, multimorbidity, older adults, preoperative assessment, prostate cancer, surgical assessment 1 | INTRODUCTION Prostate cancer is the second most common form of cancer diagnosed among men in the United States. 1 It is projected that there will be 164 690 new cases and 29 430 deaths in 2018 as a result of the disease, 2and older men represent the majority of prostate cancer diagnoses and mortalities. 3 In general, radical prostatectomy is considered one of the primary treatments available with curative intent for men diagnosed with clinically localized prostate cancer and a life expectancy of more than 10 years. 4-8 Given that older adults (defined herein as age 65 years or more 9,10 ) account for a significant ratio of the patient population, special attention and consideration must be given by surgeons and surgical teams during the stages of preoperative assessment when deciding whether or not to operate.However, the decision to operate in older adults is a complex task since the rate of adverse postoperative outcomes increases How to cite this article: Kierkegaard P, Vale MD, Garrison S, Hollenbeck BK, Hollingsworth JM, Owen-Smith J.Mechanisms of decision-making in preoperative assessment for older adult prostate cancer patients-A qualitative study.

show abstract

Accuracy of General Practitioners’ Assessment of Chest Pain Patients for Coronary Heart Disease in Primary Care: Cross-sectional Study with Follow-up

Cited by 13 publications

References 17 publications

Point-of-Care Troponin T Testing in the Management of Patients with Chest Pain in the Swedish Primary Care

Point-of-Care Troponin T Testing in the Management of Patients with Chest Pain in the Swedish Primary Care

Can emergency physicians ‘rule in’ and ‘rule out’ acute myocardial infarction with clinical judgement?

Mechanisms of decision‐making in preoperative assessment for older adult prostate cancer patients—A qualitative study

Contact Info

Product

Resources

About