Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset

被引：2

作者：

Roehle, Robert ^{[1
]}

Wieske, Viktoria ^{[1
]}

Schuetz, Georg M. ^{[1
]}

Gueret, Pascal ^{[2
]}

Andreini, Daniele ^{[3
,4
]}

Meijboom, Willem Bob ^{[5
]}

Pontone, Gianluca ^{[3
]}

Garcia, Mario ^{[6
]}

Alkadhi, Hatem ^{[7
]}

Honoris, Lily ^{[8
]}

Hausleiter, Joerg ^{[9
]}

Bettencourt, Nuno ^{[10
]}

Zimmermann, Elke ^{[1
]}

Leschka, Sebastian ^{[11
]}

Gerber, Bernhard ^{[12
]}

Rochitte, Carlos ^{[13
]}

Schoepf, U. Joseph ^{[14
]}

Shabestari, Abbas Arjmand ^{[15
]}

Norgaard, Bjarne ^{[16
]}

Sato, Akira ^{[17
]}

Knuuti, Juhani ^{[18
,19
]}

Meijs, Matthijs F. L. ^{[20
]}

Brodoefel, Harald ^{[21
]}

Jenkins, Shona M. M. ^{[22
,23
]}

Ovrehus, Kristian Altern ^{[24
,25
]}

Diederichsen, Axel Cosmus Pyndt ^{[24
]}

Hamdan, Ashraf ^{[26
,27
]}

Halvorsen, Bjorn Arild ^{[28
]}

Mendoza Rodriguez, Vladimir ^{[29
]}

Wan, Yung Liang ^{[30
,31
]}

Rixe, Johannes ^{[32
]}

Sheikh, Mehraj ^{[33
,34
]}

Langer, Christoph ^{[35
,36
]}

Ghostine, Said ^{[37
]}

Martuscelli, Eugenio ^{[38
]}

Niinuma, Hiroyuki ^{[39
]}

Scholte, Arthur ^{[40
]}

Nikolaou, Konstantin ^{[41
]}

Ulimoen, Geir ^{[42
]}

Zhang, Zhaoqi ^{[43
]}

Mickley, Hans ^{[24
]}

Nieman, Koen ^{[44
,45
]}

Kaufmann, Philipp A. ^{[46
]}

Buechel, Ronny Ralf ^{[46
]}

Herzog, Bernhard A. ^{[46
]}

Clouse, Melvin ^{[47
]}

Halon, David A. ^{[48
,49
]}

Leipsic, Jonathan ^{[50
,51
]}

Bush, David ^{[52
,53
]}

Jakamy, Reda ^{[54
]}

机构：

[1] Free Univ Berlin, Humboldt Univ Berlin, Charite Univ Med Berlin, Dept Radiol, Campus Mitte,Charitepl 1, D-10117 Berlin, Germany

[2] Univ Paris Est Creteil, Henri Mondor Hosp, Dept Cardiol, Creteil, France

[3] IRCCS, Ctr Cardiol Monzino, Milan, Italy

[4] Univ Milan, Cardiovasc Sect, Dept Clin Sci & Community Hlth, Milan, Italy

[5] IJsselland Ziekenhuis, Capelle aan den IJssel, Netherlands

[6] Montefiore, Univ Hosp, Albert Einstein Coll Med, New York, NY USA

[7] Univ Hosp Zurich, Inst Diagnost & Intervent Radiol, Zurich, Switzerland

[8] Aurora Hlth Care, Milwaukee, WI USA

[9] Ludwig Maximilians Univ Munchen, Med Klin & Poliklin 1, Munich, Germany

[10] Ctr Hosp Vila Nova de Gaia Espinho, Dept Cardiol, Gaia, Portugal

[11] Kantonsspital St Gallen, Dept Radiol & Nucl Med, St Gallen, Switzerland

[12] Clin Univ St Luc, Inst Rech Clin & Expt, Div Cardiol, Cardiovasc Ctr, Brussels, Belgium

[13] Univ Sao Paulo, Sch Med, InCor, Inst Heart, Sao Paulo, Brazil

[14] Med Univ South Carolina, Dept Radiol & Radiol Sci, Charleston, SC 29425 USA

[15] Shahid Beheshti Univ Med Sci, Modarres Hosp, Dept Radiol, Tehran, Iran

[16] Aarhus Univ Hosp Skejby, Dept Cardiol B, Aarhus, Denmark

[17] Univ Tsukuba, Cardiovasc Div, Fac Med, Tsukuba, Ibaraki, Japan

[18] Turku Univ Hosp, Turku, Finland

[19] Univ Turku, Turku, Finland

[20] Univ Med Ctr Utrecht, Dept Cardiol, Utrecht, Netherlands

[21] Univ Regensburg, Dept Radiol, Regensburg, Germany

[22] Glasgow Royal Infirm, Glasgow, Lanark, Scotland

[23] Stobhill Hosp, Glasgow, Lanark, Scotland

[24] Odense Univ Hosp, Dept Cardiol, Odense, Denmark

[25] Lillebaelt Hosp Vejle, Dept Cardiol, Vejle, Denmark

[26] Deutsch Herzzentrum Berlin, Dept Internal Med Cardiol, Berlin, Germany

[27] Chaim Sheba Med Ctr, Inst Heart, Tel Hashomer, Israel

[28] Ostfold Hosp Trust, Dept Med, Fredrikstad, Norway

[29] Natl Inst Cardiol & Cardiovasc, Surg, Havana, Cuba

[30] Chang Gung Univ, Dept Med Imaging & Radiol Sci, Coll Med, Taoyuan, Taiwan

[31] Chang Gung Mem Hosp Linkou, Dept Med Imaging & Intervent, Taoyuan, Taiwan

[32] Univ Klinikum Giessen & Marburg GmbH, Med Klin Kardiol 1, Angiol, Giessen, Germany

[33] Kuwait Univ, Dept Radiol, Fac Med, Kuwait, Kuwait

[34] Mubarak Al Kabeer Hosp, Jabriya, Kuwait

[35] UKSH, Klin Innere Med Schwerpunkt Kardiol & Angiol 3, Kiel, Germany

[36] Ruhr Univ Bochum, Univ Klin, Kardiol Klin, Herz & Diabet Zentrum Nordrhein Westfalen, Bad Oeynhausen, Germany

[37] Ctr Chirurg Marie Lannelongue, Cardiol Diagnost & Intervent, Le Plessis Robinson, France

[38] Univ Roma Tor Vergata, Dept Internal Med, Rome, Italy

[39] St Lukes Int Hosp, Dept Med, Tokyo, Japan

[40] Leiden Univ, Med Ctr, Dept Cardiol, Leiden, Netherlands

[41] Eberhard Karls Univ Tubingen, Dept Diagnost & Intervent Radiol, Tubingen, Germany

[42] Aleris Hosp, Oslo, Norway

[43] Capital Med Univ, Beijing Anzhen Hosp, Dept Radiol, Beijing, Peoples R China

[44] Erasmus MC, Dept Cardiol, Rotterdam, Netherlands

[45] Erasmus MC, Dept Radiol, Rotterdam, Netherlands

[46] Univ Hosp Zurich, Dept Nucl Med, Cardiac Imaging, Zurich, Switzerland

[47] Harvard Univ, Dept Radiol, Beth Israel Deaconess, Boston, MA 02115 USA

[48] Lady Davis Carmel Med Ctr, Dept Cardiovasc Med, Haifa, Israel

[49] Technion Israel Inst Technol, Ruth & Bruce Rappaport Fac Med, Haifa, Israel

[50] Univ British Columbia, St Pauls Hosp, Dept Radiol, Vancouver, BC, Canada

来源：

EUROPEAN RADIOLOGY | 2018年 / 28卷 / 09期

关键词：

Coronary artery disease; Multidetector computed tomography; NICE clinical guideline; Duke clinical score; Pretest probability; CT-CORONARY-ANGIOGRAPHY; ASSOCIATION TASK-FORCE; COMPUTED-TOMOGRAPHY; DIAGNOSTIC-ACCURACY; AMERICAN-COLLEGE; CALCIUM SCORES; HEART-DISEASE; METAANALYSIS; INTERVENTIONS; MANAGEMENT;

D O I：

10.1007/s00330-018-5322-5

中图分类号：

R8 [特种医学]; R445 [影像诊断学];

学科分类号：

1002 ; 100207 ; 1009 ;

摘要：

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.

引用

页码：4006 / 4017

页数：12

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