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BMJ Open. 2015 Jan 28;5(1):e007442. doi: 10.1136/bmjopen-2014-007442.

Diagnostic performance of reproducible chest wall tenderness to rule out acute coronary syndrome in acute chest pain: a prospective diagnostic study.

Author information

1
Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
2
Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland.
3
Division of Nephrology, University Hospital Zurich, Zurich, Switzerland.
4
Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland Center of Competence Multimorbidity and University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland.
5
Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland Pulmonary Division, University Hospital Zurich, Zurich, Switzerland.

Abstract

OBJECTIVES:

Acute chest pain (ACP) is a leading cause of hospital emergency unit consultation. As there are various underlying conditions, ranging from musculoskeletal disorders to acute coronary syndrome (ACS), thorough clinical diagnostics are warranted. The aim of this prospective study was to assess whether reproducible chest wall tenderness (CWT) on palpation in patients with ACP can help to rule out ACS.

METHODS:

In this prospective, double-blinded diagnostic study, all consecutive patients assessed in the emergency unit at the University Hospital Zurich because of ACP between July 2012 and December 2013 were included when a member of the study team was present. Reproducible CWT on palpation was the initial step and was recorded before further examinations were initiated. The final diagnosis was adjudicated by a study-independent physician.

RESULTS:

121 patients (60.3% male, median age 47 years, IQR 34-66.5 years) were included. The prevalence of ACS was 11.6%. Non-reproducible CWT had a high sensitivity of 92.9% (95% CI 66.1% to 98.8%) for ACS and the presence of reproducible CWT ruled out ACS (p=0.003) with a high negative predictive value (98.1%, 95% CI 89.9% to 99.7%). Conversely non-reproducible CWT ruled in ACS with low specificity (48.6%, 95% CI 38.8% to 58.5%) and low positive predictive value (19.1%, 95% CI 10.6% to 30.5%).

CONCLUSIONS:

This prospective diagnostic study supports the concept that reproducible CWT helps to rule out ACS in patients with ACP in an early stage of the evaluation process. However, ACS and other diagnoses should be considered in patients with a negative CWT test.

TRIAL REGISTRATION NUMBER:

ClinicalTrial.gov: NCT01724996.

KEYWORDS:

acute chest pain; chest wall tenderness; emergency admission; thoracic pain

PMID:
25631316
PMCID:
PMC4316553
DOI:
10.1136/bmjopen-2014-007442
[Indexed for MEDLINE]
Free PMC Article

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