Item type: | Article | ||||
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Journal or Publication Title: | European Radiology | ||||
Publisher: | Springer | ||||
Place of Publication: | NEW YORK | ||||
Volume: | 28 | ||||
Number of Issue or Book Chapter: | 9 | ||||
Page Range: | pp. 4006-4017 | ||||
Date: | 2018 | ||||
Institutions: | Medicine > Lehrstuhl für Röntgendiagnostik | ||||
Identification Number: |
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Keywords: | CORONARY-ARTERY-DISEASE; COMPUTED-TOMOGRAPHY; DIAGNOSTIC-ACCURACY; HEART-ASSOCIATION; CALCIUM SCORES; ANGIOGRAPHY; INTERVENTIONS; MANAGEMENT; LIKELIHOOD; COST; Coronary artery disease; Multidetector computed tomography; NICE clinical guideline; Duke clinical score; Pretest probability | ||||
Dewey Decimal Classification: | 600 Technology > 610 Medical sciences Medicine | ||||
Status: | Published | ||||
Refereed: | Yes, this version has been refereed | ||||
Created at the University of Regensburg: | Yes | ||||
Item ID: | 46805 |
Abstract
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. 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 ...
Abstract
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. 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). 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. 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. aEuro cent Duke clinical score is not implemented correctly in NICE guideline 95. aEuro cent Pretest probability assessment in NICE guideline 95 is impossible for most patients. aEuro cent Improved clinical decision making requires accurate pretest probability calculation. aEuro cent These refinements are essential for appropriate use of cardiac CT.
Metadata last modified: 28 Jul 2021 17:04