Abstract:
OBJECTIVES:To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. METHODS:The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT). RESULTS:4,673 individual patient data from the CoMe-CCT Consortium were analysed. Major differences in definitions in the Duke clinical score and NICE guideline were found for the predictors age and number of risk factors. Pretest probability calculation using guideline criteria was only possible for 30.8 % (1,439/4,673) of patients despite availability of all required data due to ambiguity in guideline definitions for risk factors and age groups. Agreement regarding patient management groups was found in only 70 % (366/523) of patients in whom pretest probability calculation was possible according to both models. CONCLUSIONS:Our results suggest that pretest probability calculation for clinical decision making about cardiac imaging as implemented in the NICE clinical guideline for patients has relevant limitations. KEY POINTS:• Duke clinical score is not implemented correctly in NICE guideline 95. • Pretest probability assessment in NICE guideline 95 is impossible for most patients. • Improved clinical decision making requires accurate pretest probability calculation. • These refinements are essential for appropriate use of cardiac CT.
journal_name
Eur Radioljournal_title
European radiologyauthors
Roehle R,Wieske V,Schuetz GM,Gueret P,Andreini D,Meijboom WB,Pontone G,Garcia M,Alkadhi H,Honoris L,Hausleiter J,Bettencourt N,Zimmermann E,Leschka S,Gerber B,Rochitte C,Schoepf UJ,Shabestari AA,Nørgaard B,Sato A,doi
10.1007/s00330-018-5322-5subject
Has Abstractpub_date
2018-09-01 00:00:00pages
4006-4017issue
9eissn
0938-7994issn
1432-1084pii
10.1007/s00330-018-5322-5journal_volume
28pub_type
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journal_title:European radiology
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pub_type: 临床试验,杂志文章
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pub_type: 杂志文章
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