title: Why does the general practitioner refer patients with chest pain not-urgently to the specialist or urgently to the emergency department? Influence of the certainty of the initial diagnosis.
abstract: BACKGROUND
  Chest pain is an initial symptom for several minor diseases but acute myocardial infarction (AMI) should not be missed.
  
  
  OBJECTIVE
  To assess the influence of initial diagnosis and degree of certainty of this initial diagnosis on the referral decision and the referral method (urgent-non-urgent) in patients contacting their GP with chest pain.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  The study was performed in a sentinel network of general practices in Belgium, covering almost 1.6% of the population.
  
  
  METHODS
  All patients attending their GP and complaining of chest pain during 2003.
  
  
  METHODS
  The relationships were reported as proportions and in odds ratios (OR) with their 95% confidence intervals.
  
  
  RESULTS
  1996 patients were included (men 52%). Men were referred more often (OR = 1.44; 95% CI: 1.13-1.82). Age shows no relation to referral (OR = 1.06; 95% CI: 0.83-1.35) but predicts urgent referral (OR = 1.46; 95% CI: 1.02-2.08). Odds ratios in case of serious heart disease were high with 11.58 (95% CI: 5.72-23.44) when the GP was certain of his diagnosis and 2.96 (95% CI: 1.59-5.51) if not. If the GP was uncertain, in all disease categories 54% (95% CI: 48-59) of the patients were referred non-urgently.
  
  
  CONCLUSIONS
  Referral rates for patients with chest pain were influenced by the initial diagnosis and the degree of certainty of this initial diagnosis.
authors.affiliation: Department of General Practice, Katholieke Universiteit Leuven, Belgium. Rudi.Bruyninckx@skynet.be
authors.forename: Rudi
authors.initials: R
authors.lastname: Bruyninckx
authors.forename: Ann
authors.initials: A
authors.lastname: Van den Bruel
authors.forename: Bert
authors.initials: B
authors.lastname: Aertgeerts
authors.forename: Viviane
authors.initials: V
authors.lastname: Van Casteren
authors.forename: Frank
authors.initials: F
authors.lastname: Buntinx
mesh_terms: D001530:Belgium / Q000453:epidemiology; D002637:Chest Pain / Q000175:diagnosis* / Q000453:epidemiology; D002983:Clinical Competence; D016001:Confidence Intervals; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010821:Physicians, Family / Q000592:standards* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors