Chest wall syndrome among primary care patients: a cohort study

Verdon, F; Burnand, Bernard; Herzig, Lilli; Junod, Michel; Pécoud, A; Favrat, Bernard

doi:10.1186/1471-2296-8-51

Cited by 47 publications

(41 citation statements)

References 31 publications

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“…1 Its prevalence in primary care ranges from 0.68% to 2.7%, depending on inclusion criteria and country. [2][3][4] Chest pain can be caused by a wide range of conditions, with life-threatening cardiac disease being of the greatest concern to doctors and patients. However, in primary care other aetiologies like musculoskeletal pain are far more common than coronary heart disease (CHD).…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of symptoms and signs for coronary heart disease assessed in primary care

Bösner¹,

Becker²,

Hani³

et al. 2010

Br J Gen Pract

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Diagnosing the aetiology of chest pain is challenging. There is still a lack of data on the diagnostic accuracy of signs and symptoms for acute coronary events in low-prevalence settings. AimTo evaluate the diagnostic accuracy of symptoms and signs in patients presenting to general practice with chest pain. Design of studyCross-sectional diagnostic study with delayed-type reference standard. SettingSeventy-four general practices in Germany. MethodThe study included 1249 consecutive patients presenting with chest pain. Data were reviewed by an independent reference panel, with coronary heart disease (CHD) and an indication for urgent hospital admission as reference conditions. Main outcome measures were sensitivity, specificity, likelihood ratio, predictive value, and odds ratio (OR) for non-trauma patients with a reference diagnosis. ResultsSeveral signs and symptoms showed strong associations with CHD, including known vascular disease (OR = 5.13; 95% confidence interval [CI] = 2.83 to 9.30), pain worse on exercise (OR = 4.27; 95% CI = 2.31 to 7.88), patient assumes cardiac origin of pain (OR = 3.20; 95% CI = 1.53 to 6.60), cough present (OR = 0.08; 95% CI = 0.01 to 0.77), and pain reproducible on palpation (OR = 0.27; 95% CI = 0.13 to 0.56). For urgent hospital admission, effective criteria included pain radiating to the left arm (OR = 8.81; 95% CI = 2.58 to 30.05), known clinical vascular disease (OR = 7.50; 95% CI = 2.88 to 19.55), home visit requested (OR = 7.31; 95% CI = 2.27 to 23.57), and known heart failure (OR = 3.53; 95% CI = 1.14 to 10.96). ConclusionAlthough individual criteria were only moderately effective, in combination they can help to decide about further management of patients with chest pain in primary care.Keywords chest pain; medical history taking; myocardial ischaemia; primary health care; sensitivity and specificity.

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Section: Introductionmentioning

confidence: 99%

“…However, in primary care other aetiologies like musculoskeletal pain are far more common than coronary heart disease (CHD). [3][4][5][6] Against this background, GPs face a challenge: they have to identify serious cardiac disease reliably but also limit unnecessary investigations and hospital admissions.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of symptoms and signs for coronary heart disease assessed in primary care

Bösner¹,

Becker²,

Hani³

et al. 2010

Br J Gen Pract

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“…Studies have shown a lifetime prevalence of 20% to 40% in the general population. 1 Its prevalence in primary care ranges from 0.7% to 2.7% depending on inclusion criteria and country, [2][3][4] with coronary artery disease being the underlying cause in about 12% of primary care patients. 1,5 General practitioners are challenged to identify serious cardiac disease reliably and also protect patients from unnecessary investigations and hospital admissions.…”

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confidence: 99%

Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule

Bösner¹,

Haasenritter²,

Becker³

et al. 2010

Canadian Medical Association Journal

110

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Background: Chest pain can be caused by various conditions, with life-threatening cardiac disease being of greatest concern. Prediction scores to rule out coronary artery disease have been developed for use in emergency settings. We developed and validated a simple prediction rule for use in primary care. Methods:We conducted a cross-sectional diagnostic study in 74 primary care practices in Germany. Primary care physicians recruited all consecutive patients who presented with chest pain (n = 1249) and recorded symptoms and findings for each patient (derivation cohort). An independent expert panel reviewed follow-up data obtained at six weeks and six months on symptoms, investigations, hospital admissions and medications to determine the presence or absence of coronary artery disease. Adjusted odds ratios of relevant variables were used to develop a prediction rule. We calculated measures of diagnostic accuracy for different cut-off values for the prediction scores using data derived from another prospective primary care study (validation cohort). Results:The prediction rule contained five determinants (age/sex, known vascular disease, patient assumes pain is of cardiac origin, pain is worse during exercise, and pain is not reproducible by palpation), with the score ranging from 0 to 5 points. The area under the curve (receiver operating characteristic curve) was 0.87 (95% confidence interval [CI] 0.83-0.91) for the derivation cohort and 0.90 (95% CI 0.87-0.93) for the validation cohort. The best overall discrimination was with a cut-off value of 3 (positive result 3-5 points; negative result ≤ 2 points), which had a sensitivity of 87.1% (95% CI 79.9%-94.2%) and a specificity of 80.8% (77.6%-83.9%). Interpretation:The prediction rule for coronary artery disease in primary care proved to be robust in the validation cohort. It can help to rule out coronary artery disease in patients presenting with chest pain in primary care. AbstractPreviously published at www.cmaj.ca @@

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“…16 Several studies have found chest pain of musculoskeletal etiology to be the most frequent presentation in chest pain clinics. 4,16,[20][21][22] Diagnostically, musculoskeletal chest pain can be reproduced with arm or neck movement. 23 However, as with case 1 in this study, the patient's symptoms could be reproduced with thoracic spine movements, which is a sign inconsistent of cardiovascular origin.…”

Section: Location Of Painmentioning

confidence: 99%

Presentation of Coronary Artery Disease in a Chiropractic Clinic: A Report of 2 Cases

Larson¹

2016

Journal of Chiropractic Medicine

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Objective: The purpose of this report is to describe 2 patients with coronary artery disease presenting with musculoskeletal symptoms to a chiropractic clinic. Clinical Features: A 48-year-old male new patient had thoracic spine pain aggravated by physical exertion. A 61-year-old man under routine care for low back pain experienced a secondary complaint of acute chest pain during a reevaluation. Intervention and Outcome: In both cases, the patients were strongly encouraged to consult their medical physician and were subsequently diagnosed with coronary artery disease. Following their diagnoses, each patient underwent surgical angioplasty procedures with stenting. Conclusion: Patients may present for chiropractic care with what appears to be musculoskeletal chest pain when the pain may be generating from coronary artery disease necessitating medical and possibly emergency care.

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Chest wall syndrome among primary care patients: a cohort study

Cited by 47 publications

References 31 publications

Accuracy of symptoms and signs for coronary heart disease assessed in primary care

Accuracy of symptoms and signs for coronary heart disease assessed in primary care

Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule

Presentation of Coronary Artery Disease in a Chiropractic Clinic: A Report of 2 Cases

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