Predictive ability of an early diagnostic guess in patients presenting with chest pain; a longitudinal descriptive study.
BACKGROUND
The intuitive early diagnostic guess could play an important role in reaching a final diagnosis. However, no study to date has attempted to quantify the importance of general practitioners' (GPs) ability to correctly appraise the origin of chest pain within the first minutes of an encounter.


METHODS
The validation study was nested in a multicentre cohort study with a one year follow-up and included 626 successive patients who presented with chest pain and were attended by 58 GPs in Western Switzerland. The early diagnostic guess was assessed prior to a patient's history being taken by a GP and was then compared to a diagnosis of chest pain observed over the next year.


RESULTS
Using summary measures clustered at the GP's level, the early diagnostic guess was confirmed by further investigation in 51.0% (CI 95%; 49.4% to 52.5%) of patients presenting with chest pain. The early diagnostic guess was more accurate in patients with a life threatening illness (65.4%; CI 95% 64.5% to 66.3%) and in patients who did not feel anxious (62.9%; CI 95% 62.5% to 63.3%). The predictive abilities of an early diagnostic guess were consistent among GPs.


CONCLUSIONS
The GPs early diagnostic guess was correct in one out of two patients presenting with chest pain. The probability of a correct guess was higher in patients with a life-threatening illness and in patients not feeling anxious about their pain.
Verdon
François
F
Institute of General Medicine, University of Lausanne, Bugnon 44, 1011 Lausanne, Switzerland.
Junod
Michel
M
Herzig
Lilli
L
Vaucher
Paul
P
Burnand
Bernard
B
Bischoff
Thomas
T
Pécoud
Alain
A
Favrat
Bernard
B
D002637:Chest Pain / Q000209:etiology*; D015331:Cohort Studies; D042241:Early Diagnosis; D005767:Gastrointestinal Diseases / Q000150:complications / Q000175:diagnosis; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis; D015337:Multicenter Studies as Topic; D010821:Physicians, Family; D011237:Predictive Value of Tests; D013557:Switzerland