Chest pain for coronary heart disease in general practice: clinical judgement and a clinical decision rule.
BACKGROUND
The Marburg Heart Score (MHS) is a simple, valid, and robust clinical decision rule assisting GPs in ruling out coronary heart disease (CHD) in patients presenting with chest pain.


OBJECTIVE
To investigate whether using the rule adds to the GP's clinical judgement.


METHODS
A comparative diagnostic accuracy study was conducted using data from 832 consecutive patients with chest pain in general practice.


METHODS
Three diagnostic strategies were defined using the MHS: diagnosis based solely on the MHS; using the MHS as a triage test; and GP's clinical judgement aided by the MHS. Their accuracy was compared with the GPs' unaided clinical judgement.


RESULTS
Sensitivity and specificity of the GPs' unaided clinical judgement was 82.9% (95% confidence interval [CI] = 72.4 to 89.9) and 61.0% (95% CI = 56.7 to 65.2), respectively. In comparison, the sensitivity of the MHS was higher (difference 8.5%, 95% CI = -2.4 to 19.6) and the specificity was similar (difference -0.4%, 95% CI = -5.3 to 4.5); the sensitivity of the triage was similar (difference -1.5%, 95% CI = -9.8 to 7.0) and the specificity was higher (difference 11.6%, 95% CI = 7.8 to 15.4); and both the sensitivity and specificity of the aided clinical judgement were higher (difference 8.0%, 95% CI = -6.9 to 23.0 and 5.8%, 95% CI = -1.6 to 13.2, respectively).


CONCLUSIONS
Using the Marburg Heart Score for initial triage can improve the clinical diagnosis of CHD in general practice.
Department of General Practice/Family Medicine, Philipps University of Marburg, Marburg, Germany.
Jörg
J
Haasenritter
Department of General Practice/Family Medicine, Philipps University of Marburg, Marburg, Germany.
Norbert
N
Donner-Banzhoff
Department of General Practice/Family Medicine, Philipps University of Marburg, Marburg, Germany.
Stefan
S
Bösner
D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000209:etiology*; D000066491:Clinical Decision-Making; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012015:Reference Standards; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D014218:Triage / Q000379:methods*
chest pain; medical history taking; myocardial ischaemia; primary health care; sensitivity and specificity