PMID- 24207111
OWN - NLM
STAT- MEDLINE
DCOM- 20140326
LR  - 20211021
IS  - 1741-7015 (Electronic)
IS  - 1741-7015 (Linking)
VI  - 11
DP  - 2013 Nov 8
TI  - Diagnostic indicators of non-cardiovascular chest pain: a systematic review and 
      meta-analysis.
PG  - 239
LID - 10.1186/1741-7015-11-239 [doi]
AB  - BACKGROUND: Non-cardiovascular chest pain (NCCP) has a high healthcare cost, but 
      insufficient guidelines exist for its diagnostic investigation. The objective of 
      the present work was to identify important diagnostic indicators and their 
      accuracy for specific and non-specific conditions underlying NCCP. METHODS: A 
      systematic review and meta-analysis were performed. In May 2012, six databases 
      were searched. Hand and bibliography searches were also conducted. Studies 
      evaluating a diagnostic test against a reference test in patients with NCCP were 
      included. Exclusion criteria were having <30 patients per group, and evaluating 
      diagnostic tests for acute cardiovascular disease. Diagnostic accuracy is given 
      in likelihood ratios (LR): very good (LR+ >10, LR- <0.1); good (LR + 5 to 10, LR- 
      0.1 to 0.2); fair (LR + 2 to 5, LR- 0.2 to 0.5); or poor (LR + 1 to 2, LR- 0.5 to 
      1). Joined meta-analysis of the diagnostic test sensitivity and specificity was 
      performed by applying a hierarchical Bayesian model. RESULTS: Out of 6,316 
      records, 260 were reviewed in full text, and 28 were included: 20 investigating 
      gastroesophageal reflux disorders (GERD), 3 musculoskeletal chest pain, and 5 
      psychiatric conditions. Study quality was good in 15 studies and moderate in 13. 
      GERD diagnosis was more likely with typical GERD symptoms (LR + 2.70 and 2.75, 
      LR- 0.42 and 0.78) than atypical GERD symptoms (LR + 0.49, LR- 2.71). GERD was 
      also more likely with a positive response to a proton pump inhibitor (PPI) test 
      (LR + 5.48, 7.13, and 8.56; LR- 0.24, 0.25, and 0.28); the posterior mean 
      sensitivity and specificity of six studies were 0.89 (95% credible interval, 0.28 
      to 1) and 0.88 (95% credible interval, 0.26 to 1), respectively. Panic and 
      anxiety screening scores can identify individuals requiring further testing for 
      anxiety or panic disorders. Clinical findings in musculoskeletal pain either had 
      a fair to moderate LR + and a poor LR- or vice versa. CONCLUSIONS: In patients 
      with NCCP, thorough clinical evaluation of the patient's history, symptoms, and 
      clinical findings can indicate the most appropriate diagnostic tests. Treatment 
      response to high-dose PPI treatment provides important information regarding 
      GERD, and should be considered early. Panic and anxiety disorders are often 
      undiagnosed and should be considered in the differential diagnosis of chest pain.
FAU - Wertli, Maria M
AU  - Wertli MM
AD  - Horten Center for Patient Oriented Research and Knowledge Transfer, Department of 
      Internal Medicine, University of Zurich, Pestalozzistrasse 24, CH-8032, Zurich, 
      Switzerland. Maria.Wertli@usz.ch.
FAU - Ruchti, Katrin B
AU  - Ruchti KB
FAU - Steurer, Johann
AU  - Steurer J
FAU - Held, Ulrike
AU  - Held U
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20131108
PL  - England
TA  - BMC Med
JT  - BMC medicine
JID - 101190723
SB  - IM
MH  - Chest Pain/*diagnosis/*etiology
MH  - Diagnostic Tests, Routine/*methods
MH  - Humans
MH  - Sensitivity and Specificity
PMC - PMC4226211
EDAT- 2013/11/12 06:00
MHDA- 2014/03/29 06:00
PMCR- 2013/11/08
CRDT- 2013/11/12 06:00
PHST- 2013/06/18 00:00 [received]
PHST- 2013/10/15 00:00 [accepted]
PHST- 2013/11/12 06:00 [entrez]
PHST- 2013/11/12 06:00 [pubmed]
PHST- 2014/03/29 06:00 [medline]
PHST- 2013/11/08 00:00 [pmc-release]
AID - 1741-7015-11-239 [pii]
AID - 10.1186/1741-7015-11-239 [doi]
PST - epublish
SO  - BMC Med. 2013 Nov 8;11:239. doi: 10.1186/1741-7015-11-239.