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

Robert Roehle, Viktoria Wieske, Georg M. Schuetz, Pascal Gueret, Daniele Andreini, Willem Bob Meijboom, Gianluca Pontone, Mario Garcia, Hatem Alkadhi, Lily Honoris, Jörg Hausleiter, Nuno Bettencourt, Elke Zimmermann, Sebastian Leschka, Bernhard Gerber, Carlos Rochitte, U. Joseph Schoepf, Abbas Arjmand Shabestari, Bjarne Nørgaard, Akira SatoJuhani Knuuti, Matthijs F.L. Meijs, Harald Brodoefel, Shona M.M. Jenkins, Kristian Altern Øvrehus, Axel Cosmus Pyndt Diederichsen, Ashraf Hamdan, Bjørn Arild Halvorsen, Vladimir Mendoza Rodriguez, Yung Liang Wan, Johannes Rixe, Mehraj Sheikh, Christoph Langer, Said Ghostine, Eugenio Martuscelli, Hiroyuki Niinuma, Arthur Scholte, Konstantin Nikolaou, Geir Ulimoen, Zhaoqi Zhang, Hans Mickley, Koen Nieman, Philipp A. Kaufmann, Ronny Ralf Buechel, Bernhard A. Herzog, Melvin Clouse, David A. Halon, Jonathan Leipsic, David Bush, Reda Jakamy, Kai Sun, Lin Yang, Thorsten Johnson, Jean Pierre Laissy, Roy Marcus, Simone Muraglia, Jean Claude Tardif, Benjamin Chow, Narinder Paul, David Maintz, John Hoe, Albert de Roos, Robert Haase, Michael Laule, Peter Schlattmann, Marc Dewey

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)4006-4017
Number of pages12
JournalEuropean Radiology
Volume28
Issue number9
DOIs
Publication statusPublished - Sep 1 2018

Keywords

  • Coronary artery disease
  • Duke clinical score
  • Multidetector computed tomography
  • NICE clinical guideline
  • Pretest probability

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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