PMID- 22377444
OWN - NLM
STAT- MEDLINE
DCOM- 20120815
LR  - 20181201
IS  - 1532-6586 (Electronic)
IS  - 0161-4754 (Linking)
VI  - 35
IP  - 3
DP  - 2012 Mar-Apr
TI  - Reconstruction of the decision-making process in assessing musculoskeletal chest 
      pain: an exploratory study using recursive partitioning.
PG  - 184-95
LID - 10.1016/j.jmpt.2012.01.009 [doi]
AB  - OBJECTIVE: The purposes of this study were to identify the most important 
      determinants from the patient history and clinical examination in diagnosing 
      musculoskeletal chest pain (MSCP) in patients with acute noncardiac chest pain 
      when supported by a structured protocol and to construct a decision tree for 
      identification of MSCP in acute noncardiac chest pain. METHODS: Consecutive 
      patients with noncardiac chest pain (n = 302) recruited from an emergency 
      cardiology department were assessed. Using data from self-report questionnaires, 
      interviews, and clinical assessment, patient characteristics were associated with 
      the MSCP diagnosis, and the decision-making process of the clinician was 
      reconstructed using recursive procedures in the tradition of constructing 
      Classification and Regression Trees. RESULTS: Thirty-eight percent of patients 
      had MSCP. There was no single determinant that predicted the condition 
      completely. However, many items with high associations could be identified, 
      mainly with high negative predictive value. The decision-making process was 
      reconstructed giving rise to a 5-step, linear decision tree without branches. 
      CONCLUSIONS: Clinicians use a combination of indicators including systematic 
      palpation of the spine and chest wall and items from the case history to diagnose 
      MSCP. However, the high negative predictive values of the main determinants 
      suggest that the MSCP diagnosis may be a diagnosis by exclusion.
CI  - Copyright (c) 2012 National University of Health Sciences. Published by Mosby, Inc. 
      All rights reserved.
FAU - Stochkendahl, Mette J
AU  - Stochkendahl MJ
AD  - Nordic Institute of Chiropractic and Clinical Biomechanics & Institute of Sports 
      Science and Clinical Biomechanics, University of Southern Denmark, Part of 
      Clinical Locomotion Network, Odense, Denmark. m.jensen@nikkb.dk
FAU - Vach, Werner
AU  - Vach W
FAU - Hartvigsen, Jan
AU  - Hartvigsen J
FAU - Hoilund-Carlsen, Poul F
AU  - Hoilund-Carlsen PF
FAU - Haghfelt, Torben
AU  - Haghfelt T
FAU - Christensen, Henrik W
AU  - Christensen HW
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20120227
PL  - United States
TA  - J Manipulative Physiol Ther
JT  - Journal of manipulative and physiological therapeutics
JID - 7807107
SB  - IM
MH  - Acute Disease
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Chest Pain/classification/*diagnosis/epidemiology
MH  - Cohort Studies
MH  - Decision Support Techniques
MH  - *Decision Trees
MH  - Denmark
MH  - Diagnosis, Differential
MH  - Emergency Service, Hospital/statistics & numerical data
MH  - Female
MH  - Hospitals, University
MH  - Humans
MH  - Linear Models
MH  - Male
MH  - Medical History Taking/*methods
MH  - Middle Aged
MH  - Musculoskeletal Pain/classification/*diagnosis/epidemiology
MH  - Palpation/*methods
MH  - Physical Examination/methods
MH  - Predictive Value of Tests
MH  - Risk Assessment
MH  - Sensitivity and Specificity
MH  - Severity of Illness Index
MH  - Sex Factors
MH  - Surveys and Questionnaires
EDAT- 2012/03/02 06:00
MHDA- 2012/08/16 06:00
CRDT- 2012/03/02 06:00
PHST- 2011/08/30 00:00 [received]
PHST- 2011/11/14 00:00 [revised]
PHST- 2011/11/14 00:00 [accepted]
PHST- 2012/03/02 06:00 [entrez]
PHST- 2012/03/02 06:00 [pubmed]
PHST- 2012/08/16 06:00 [medline]
AID - S0161-4754(12)00030-9 [pii]
AID - 10.1016/j.jmpt.2012.01.009 [doi]
PST - ppublish
SO  - J Manipulative Physiol Ther. 2012 Mar-Apr;35(3):184-95. doi: 
      10.1016/j.jmpt.2012.01.009. Epub 2012 Feb 27.