Accuracy of the general practitioner’s sense of alarm when confronted with dyspnoea and/or chest pain: a prospective observational study

Abstract

ObjectivesDyspnoea and chest pain are symptoms shared with multiple pathologies ranging from the benign to life-threatening diseases. A Gut Feelings Questionnaire (GFQ) has been validated to measure the general practitioner’s (GPs) sense of alarm or sense of reassurance. The aim of the study was to estimate the diagnostic test accuracy of GPs’ sense of alarm when confronted with dyspnoea and chest pain.Design and settingsProspective observational study in general practice.ParticipantsPatients aged between 18 and 80 years, consulting their GP for dyspnoea and/or chest pain, were considered for enrolment. These GPs had to complete the GFQ immediately after the consultation.Primary outcome measuresLife-threatening and non-life-threatening diseases have previously been defined according to the pathologies or symptoms in the International Classification of Primary Care (ICPC)-2 classification. The index test was the sense of alarm and the reference standard was the final diagnosis at 4 weeks.Results25 GPs filled in 235 GFQ questionnaires. The positive likelihood ratio for the sense of alarm was 2.12 (95% CI 1.49 to 2.82), the negative likelihood ratio was 0.55 (95% CI 0.37 to 0.77).ConclusionsWhere the physician experienced a sense of alarm when a patient consulted him/her for dyspnoea and/or chest pain, the post-test odds that this patient had, in fact, a life-threatening disease was about twice as high as the pretest odds.Trial registration numberNCT02932982.

How child health care physicians struggle from gut feelings to managing suspicions of child abuse

“…There have been many studies, showing the positive predictive value of gut feelings that lead to working hypotheses such as cancer, lung embolism and serious childhood infections. [26][27][28] Child abuse is often hidden, and a gut feeling might be an important signal to become suspicious, to observe more closely and to examine the child better.…”

“…Based on previous studies, we are in principle of the opinion that gut feelings are not right or wrong, but might raise the suspicion of a potentially serious problem, in our case that of child abuse, and might induce further diagnostics and actions. There have been many studies, showing the positive predictive value of gut feelings that lead to working hypotheses such as cancer, lung embolism and serious childhood infections 26‐28 . Child abuse is often hidden, and a gut feeling might be an important signal to become suspicious, to observe more closely and to examine the child better.…”

Performance of risk scores for coronary artery disease: a retrospective cohort study of patients with chest pain in urgent primary care

“…The INTERCHEST score includes the GP’s sense of alarm by administering points when the GP initially suspected a serious condition. A recent study by Barais et al 19 evaluated GPs sense of alarm using a validated ‘Gut Feelings Questionnaire’ in primary care patients presenting with chest pain and dyspnoea. The study showed that the probability of a life-threatening disease increases from 20% to 35% when a sense of alarm is present.…”

Prospective Observational Study on the Prevalence and Diagnostic Value of General Practitioners’ Gut Feelings for Cancer and Serious Diseases

“…There are many studies regarding the use of gut feelings by GPs, hospital specialists, and nurses 9,[11][12][13][14][15][16][17] . GPs reported using their gut feelings in suspecting cancer 9,[17][18][19][20] and other serious diseases 21,22 .…”