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Eur Radiol. 2018 Sep;28(9):4006-4017. doi: 10.1007/s00330-018-5322-5. Epub 2018 Mar 19.

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.

Author information

1
Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
2
Cardiology Department, Henri Mondor Hospital, University Paris Est Creteil, Créteil, France.
3
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
4
Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
5
IJsselland Ziekenhuis, Capelle a/d IJssel, The Netherlands.
6
Montefiore, the University Hospital for the Albert Einstein College of Medicine, New York City, NY, USA.
7
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
8
Aurora Health Care, Milwaukee, WI, USA.
9
Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-University of Munich, Munich, Germany.
10
Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Gaia, Portugal.
11
Department of Radiology and Nuclear Medicine Kantonsspital St. Gallen, St. Gallen, Switzerland.
12
Division of Cardiology, Cardiovascular Center, Cliniques Universitaires St. Luc, Institut de Recherche Clinique et Experimentale, Brussels, Belgium.
13
Heart Institute - InCor - University of São Paulo Medical School, São Paulo, Brazil.
14
Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
15
Department of Radiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
16
Department Cardiology B, Aarhus University Hospital Skejby, Aarhus, Denmark.
17
Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
18
Turku University Hospital and University of Turku, Turku, Finland.
19
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
20
Department of Radiology, University of Regensburg, Regensburg, Germany.
21
Glasgow Royal Infirmary and Stobhill Hospital, Glasgow, UK.
22
Department of Cardiology, Odense University Hospital, Odense, Denmark.
23
Department of Cardiology Lillebælt Hospital -Vejle, Vejle, Denmark.
24
Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
25
Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.
26
Medical Department, Ostfold Hospital Trust, Fredrikstad, Norway.
27
National Institute of Cardiology and Cardiovascular, Surgery, Havana, Cuba.
28
Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
29
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
30
Medizinische Klinik I (Kardiologie, Angiologie), Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany.
31
Department of Radiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
32
Mubarak Al Kabeer Hospital, Jabriya, Kuwait.
33
Klinik für Innere Medizin III mit Schwerpunkt Kardiologie und Angiologie, UKSH, Kiel, Germany.
34
Kardiologische Klinik, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
35
Cardiologie diagnostique et interventionnelle, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
36
Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy.
37
Department of Medicine, St. Luke's International Hospital, Tokyo, Japan.
38
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
39
Department of Diagnostic and Interventional Radiology, Eberhard Karls Universität Tübingen, Tübingen, Germany.
40
Aleris Hospital, Oslo, Norway.
41
Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
42
Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
43
Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
44
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.
45
Department of Radiology, Beth Israel Deaconess, Harvard University, Boston, MA, USA.
46
Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.
47
Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
48
Department of Radiology and Division of Cardiology UBC, St Paul's Hospital, Vancouver, Canada.
49
Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA.
50
Department of Cardiology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
51
Department of Interventional Cardiology, University Hospital Cochin, Paris, France.
52
Department of Radiology, Baotou Central Hospital, Baotou Shi, Inner Mongolia Province, China.
53
Department of Clinical Radiology, Hospital Grosshadern of the University of Munich, Munich, Germany.
54
Department of Diagnostic Imaging and Interventional Radiology, Bichat University Hospital, Paris, France.
55
Department of Clinical Radiology, Munich, Ludwig-Maximilians-University of Munich, Munich, Germany.
56
Cardiology Department, S. Chiara Hospital, Trento, Italy.
57
Research Center Montreal Heart Institute, Université de Montréal, Montréal, Canada.
58
University of Ottawa, Heart Institute, Ottawa, Canada.
59
Joint Department of Medical Imaging, University Health Network, Mount Sinai and Women's College Hospitals, Toronto, Canada.
60
University of Toronto, Toronto, Canada.
61
Institute and Polyclinic for Diagnostic Radiology, University of Cologne, Cologne, Germany.
62
Department of Diagnostic Radiology, Mt Elizabeth Hospital, Singapore, Singapore.
63
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
64
Department of Cardiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany.
65
Department of Medical Statistics, Informatics and Documentation, University Hospital of Friedrich Schiller University Jena, Jena, Germany.
66
Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany. marc.dewey@charite.de.

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.

KEYWORDS:

Coronary artery disease; Duke clinical score; Multidetector computed tomography; NICE clinical guideline; Pretest probability

PMID:
29556770
DOI:
10.1007/s00330-018-5322-5
[Indexed for MEDLINE]

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