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19.03.2018 | Cardiac

Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset

verfasst von: Robert Roehle, Viktoria Wieske, Georg M. Schuetz, Pascal Gueret, Daniele Andreini, Willem Bob Meijboom, Gianluca Pontone, Mario Garcia, Hatem Alkadhi, Lily Honoris, Jörg Hausleiter, Nuno Bettencourt, Elke Zimmermann, Sebastian Leschka, Bernhard Gerber, Carlos Rochitte, U. Joseph Schoepf, Abbas Arjmand Shabestari, Bjarne Nørgaard, Akira Sato, Juhani Knuuti, Matthijs F. L. Meijs, Harald Brodoefel, Shona M. M. Jenkins, Kristian Altern Øvrehus, Axel Cosmus Pyndt Diederichsen, Ashraf Hamdan, Bjørn Arild Halvorsen, Vladimir Mendoza Rodriguez, Yung Liang Wan, Johannes Rixe, Mehraj Sheikh, Christoph Langer, Said Ghostine, Eugenio Martuscelli, Hiroyuki Niinuma, Arthur Scholte, Konstantin Nikolaou, Geir Ulimoen, Zhaoqi Zhang, Hans Mickley, Koen Nieman, Philipp A. Kaufmann, Ronny Ralf Buechel, Bernhard A. Herzog, Melvin Clouse, David A. Halon, Jonathan Leipsic, David Bush, Reda Jakamy, Kai Sun, Lin Yang, Thorsten Johnson, Jean-Pierre Laissy, Roy Marcus, Simone Muraglia, Jean-Claude Tardif, Benjamin Chow, Narinder Paul, David Maintz, John Hoe, Albert de Roos, Robert Haase, Michael Laule, Peter Schlattmann, Marc Dewey

Erschienen in: European Radiology | Ausgabe 9/2018

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Abstract

Objectives

To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset.

Methods

The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT).

Results

4,673 individual patient data from the CoMe-CCT Consortium were analysed. Major differences in definitions in the Duke clinical score and NICE guideline were found for the predictors age and number of risk factors. Pretest probability calculation using guideline criteria was only possible for 30.8 % (1,439/4,673) of patients despite availability of all required data due to ambiguity in guideline definitions for risk factors and age groups. Agreement regarding patient management groups was found in only 70 % (366/523) of patients in whom pretest probability calculation was possible according to both models.

Conclusions

Our results suggest that pretest probability calculation for clinical decision making about cardiac imaging as implemented in the NICE clinical guideline for patients has relevant limitations.

Key Points

• Duke clinical score is not implemented correctly in NICE guideline 95.

• Pretest probability assessment in NICE guideline 95 is impossible for most patients.

• Improved clinical decision making requires accurate pretest probability calculation.

• These refinements are essential for appropriate use of cardiac CT.

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Titel: Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset
verfasst von: Robert Roehle
Viktoria Wieske
Georg M. Schuetz
Pascal Gueret
Daniele Andreini
Willem Bob Meijboom
Gianluca Pontone
Mario Garcia
Hatem Alkadhi
Lily Honoris
Jörg Hausleiter
Nuno Bettencourt
Elke Zimmermann
Sebastian Leschka
Bernhard Gerber
Carlos Rochitte
U. Joseph Schoepf
Abbas Arjmand Shabestari
Bjarne Nørgaard
Akira Sato
Juhani Knuuti
Matthijs F. L. Meijs
Harald Brodoefel
Shona M. M. Jenkins
Kristian Altern Øvrehus
Axel Cosmus Pyndt Diederichsen
Ashraf Hamdan
Bjørn Arild Halvorsen
Vladimir Mendoza Rodriguez
Yung Liang Wan
Johannes Rixe
Mehraj Sheikh
Christoph Langer
Said Ghostine
Eugenio Martuscelli
Hiroyuki Niinuma
Arthur Scholte
Konstantin Nikolaou
Geir Ulimoen
Zhaoqi Zhang
Hans Mickley
Koen Nieman
Philipp A. Kaufmann
Ronny Ralf Buechel
Bernhard A. Herzog
Melvin Clouse
David A. Halon
Jonathan Leipsic
David Bush
Reda Jakamy
Kai Sun
Lin Yang
Thorsten Johnson
Jean-Pierre Laissy
Roy Marcus
Simone Muraglia
Jean-Claude Tardif
Benjamin Chow
Narinder Paul
David Maintz
John Hoe
Albert de Roos
Robert Haase
Michael Laule
Peter Schlattmann
Marc Dewey
Publikationsdatum: 19.03.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 9/2018
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5322-5

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Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset