Izvorni znanstveni članak
Does the patient with chest pain have a coronary heart disease? Diagnostic value of single symptoms and signs – a meta-analysis
Jörg Haasenritter
; Department of General Practice/Family Medicine, Philipps University of Marburg, Marburg, Germany
Damaris Stanze
; Department of Cardiology,Dr. Horst-Schmidt-Hospital, Wiesbaden, Germany
Grit Widera
; Department of General Practice/Family Medicine, Philipps University of Marburg, Marburg, Germany
Christian Wilimzig
; Department of General Practice/Family Medicine, Philipps University of Marburg, Marburg, Germany
Maren Abu Hani
; Department of General Practice/Family Medicine, Philipps University of Marburg, Marburg, Germany
Andreas C Sönnichsen
; Department of Family Medicine Paracelsus University, Salzburg, Austria
Stefan Bösner
; Department of General Practice/Family Medicine, Philipps University of Marburg, Marburg, Germany
Justine Rochon
; Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
Norbert Donner-Banzhoff
; Department of General Practice/Family Medicine, Philipps University of Marburg, Marburg, Germany
Sažetak
Aim To determine the diagnostic value of single symptoms
and signs for coronary heart disease (CHD) in patients with
chest pain.
Methods Searches of two electronic databases (EMBASE
1980 to March 2008, PubMed 1970 to May 2009) and hand
searching in seven journals were conducted. Eligible studies
recruited patients presenting with acute or chronic
chest pain. The target disease was CHD, with no restrictions
regarding case definitions, eg, stable CHD, acute coronary
syndrome (ACS), acute myocardial infarction (MI), or major
cardiac event (MCE). Diagnostic tests of interest were items
of medical history and physical examination. Bivariate random
effects model was used to derive summary estimates
of positive (pLR) and negative likelihood ratios (nLR).
Results We included 172 studies providing data on the
diagnostic value of 42 symptoms and signs. With respect
to case definition of CHD, diagnostically most useful tests
were history of CHD (pLR = 3.59), known MI (pLR = 3.21),
typical angina (pLR = 2.35), history of diabetes mellitus
(pLR = 2.16), exertional pain (pLR = 2.13), history of angina
pectoris (nLR = 0.42), and male sex (nLR = 0.49) for diagnosing
stable CHD; pain radiation to right arm/shoulder
(pLR = 4.43) and palpitation (pLR = 0.47) for diagnosing
MI; visceral pain (pLR = 2.05) for diagnosing ACS; and typical
angina (pLR = 2.60) and pain reproducible by palpation
(pLR = 0.13) for predicting MCE.
Conclusions We comprehensively reported the accuracy
of a broad spectrum of single symptoms and signs for diagnosing
myocardial ischemia. Our results suggested that
the accuracy of several symptoms and signs varied in the
published studies according to the case definition of CHD.
Ključne riječi
Hrčak ID:
94935
URI
Datum izdavanja:
15.10.2012.
Posjeta: 1.980 *