title: The accuracy of the general practitioner's sense of alarm when confronted with dyspnoea and/or thoracic pain: protocol for a prospective observational study.
abstract: BACKGROUND
  Dyspnoea and chest pain are signs shared with multiple pathologies ranging from the benign to life-threatening diseases. Gut feelings such as the sense of alarm and the sense of reassurance are known to play a substantial role in the diagnostic reasoning of general practitioners (GPs). A Gut Feelings Questionnaire (GFQ) has been validated to measure the GP's sense of alarm. A French version of the GFQ is available following a linguistic validation procedure. The aim of the study is to calculate the diagnostic test accuracy of a GP's sense of alarm when confronted with dyspnoea and chest pain.
  
  
  METHODS
  Prospective observational study. Patients aged between 18 and 80 years, consulting their GP for dyspnoea and/or thoracic pain will be considered for enrolment in the study. These GPs will have to complete the questionnaire immediately after the consultation for dyspnoea and/or thoracic pain. The follow-up and the final diagnosis will be collected 4 weeks later by phone contact with the GP or with the patient if their GP has no information. Life-threatening and non-life-threatening diseases have previously been defined according to the pathologies or symptoms in the (ICPC2) International Collegiate Programming Contest classification. Members of the research team, blinded to the actual outcomes shown on the index questionnaire, will judge each case in turn and will, by consensus, classify the expected outcomes as either life-threatening or non-life-threatening diseases. The sensitivity, the specificity, the positive and negative likelihood ratio of the sense of alarm will be calculated from the constructed contingency table.
  
  
  BACKGROUND
  This study was approved by the ethical committee of the University de Bretagne Occidentale. A written informed consent form will be signed and dated by GPs and patients at the beginning of the study. The results will be published in due course.
authors.affiliation: ERCR SPURBO, Department of General Practice, Univeristé de Bretagne Occidentale, Brest, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Barais
authors.affiliation: ERCR SPURBO, Department of General Practice, Univeristé de Bretagne Occidentale, Brest, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Barraine
authors.affiliation: ERCR SPURBO, Department of General Practice, Univeristé de Bretagne Occidentale, Brest, France.
authors.forename: Florie
authors.initials: F
authors.lastname: Scouarnec
authors.affiliation: ERCR SPURBO, Department of General Practice, Univeristé de Bretagne Occidentale, Brest, France.
authors.forename: Anne Sophie
authors.initials: AS
authors.lastname: Mauduit
authors.affiliation: ERCR SPURBO, Department of General Practice, Univeristé de Bretagne Occidentale, Brest, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Le Floc'h
authors.affiliation: Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Van Royen
authors.affiliation: ERCR SPURBO, Public Health Department, Université de Bretagne Occidentale, Brest, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Liétard
authors.affiliation: Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium Department of General Practice, Faculty of Health, Medicine and Life Sciences, Caphri School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Stolper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D032921:Consensus; D016638:Critical Illness; D004417:Dyspnea / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D058006:General Practice; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D019545:Intuition; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011446:Prospective Studies; D012017:Referral and Consultation; D012107:Research Design; D012677:Sensation; D011795:Surveys and Questionnaires; D063189:Symptom Assessment / Q000379:methods / Q000592:standards; D055815:Young Adult
keywords: Adult cardiology < CARDIOLOGY; PRIMARY CARE; Thromboembolism < CARDIOLOGY