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

Publication

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

Journal Paper/Review - Mar 19, 2018

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

Citation

Dewey M, Leipsic J, Halon D, Clouse M, Herzog B, Buechel R, Kaufmann P, Nieman K, Mickley H, Zhang Z, Ulimoen G, Nikolaou K, Scholte A, Niinuma H, Martuscelli E, Bush D, Jakamy R, Sun K, Schlattmann P, Laule M, Haase R, de Roos A, Hoe J, Maintz D, Paul N, Chow B, Tardif J, Muraglia S, Marcus R, Laissy J, Johnson T, Yang L, Ghostine S, Langer C, Gerber B, Leschka S, Zimmermann E, Bettencourt N, Hausleiter J, Honoris L, Alkadhi H, Garcia M, Pontone G, Meijboom W, Andreini D, Gueret P, Schuetz G, Wieske V, Rochitte C, Schoepf U, Shabestari A, Sheikh M, Rixe J, Wan Y, Mendoza Rodriguez V, Halvorsen B, Hamdan A, Diederichsen A, Øvrehus K, Jenkins S, Brodoefel H, Meijs M, Knuuti J, Sato A, Nørgaard B, Roehle R. 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. Eur Radiol 2018; 28:4006-4017.

Type

Journal Paper/Review (English)

Journal

Eur Radiol 2018; 28

Publication Date

Mar 19, 2018

Issn Electronic

1432-1084

Pages

4006-4017

Brief description/objective

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.