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

Robert Roehle, Viktoria Wieske, Georg M. Schuetz, Pascal Gueret, Daniele Andreini, Willem Bob Meijboom, Gianluca Pontone, Mario J. Garcia, Hatem Alkadhi, Lily Honoris, Jörg Hausleiter, Nuno Bettencourt, Elke Zimmermann, Sebastian Leschka, Bernhard Gerber, Carlos Rochitte, U. Joseph Schoepf, Abbas Arjmand Shabestari, Bjarne Nørgaard, Akira Sato & 46 others Juhani Knuuti, Matthijs F.L. Meijs, Harald Brodoefel, Shona M.M. Jenkins, Kristian Altern Øvrehus, Axel Cosmus Pyndt Diederichsen, Ashraf Hamdan, Bjørn Arild Halvorsen, Vladimir Mendoza Rodriguez, Yung Liang Wan, Johannes Rixe, Mehraj Sheikh, Christoph Langer, Said Ghostine, Eugenio Martuscelli, Hiroyuki Niinuma, Arthur Scholte, Konstantin Nikolaou, Geir Ulimoen, Zhaoqi Zhang, Hans Mickley, Koen Nieman, Philipp Kaufmann, Ronny Ralf Büchel, Bernhard Herzog, Melvin Clouse, David A. Halon, Jonathan Leipsic, David Bush, Reda Jakamy, Kai Sun, Lin Yang, Thorsten Johnson, Jean Pierre Laissy, Roy Marcus, Simone Muraglia, Jean Claude Tardif, Benjamin Chow, Narinder Paul, David Maintz, John Hoe, Albert de Roos, Robert Haase, Michael Laule, Peter Schlattmann, Marc Dewey

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1-12
Number of pages12
JournalEuropean Radiology
DOIs
StateAccepted/In press - Mar 19 2018

Fingerprint

Chest Pain
Guidelines
Meta-Analysis
Clinical Decision-Making
Decision Making
Age Groups

Keywords

  • Coronary artery disease
  • Duke clinical score
  • Multidetector computed tomography
  • NICE clinical guideline
  • Pretest probability

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

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

In: European Radiology, 19.03.2018, p. 1-12.

Research output: Contribution to journalArticle

Roehle, R, Wieske, V, Schuetz, GM, Gueret, P, Andreini, D, Meijboom, WB, Pontone, G, Garcia, MJ, Alkadhi, H, Honoris, L, Hausleiter, J, Bettencourt, N, Zimmermann, E, Leschka, S, Gerber, B, Rochitte, C, Schoepf, UJ, Shabestari, AA, Nørgaard, B, Sato, A, Knuuti, J, Meijs, MFL, Brodoefel, H, Jenkins, SMM, Øvrehus, KA, Diederichsen, ACP, Hamdan, A, Halvorsen, BA, Mendoza Rodriguez, V, Wan, YL, Rixe, J, Sheikh, M, Langer, C, Ghostine, S, Martuscelli, E, Niinuma, H, Scholte, A, Nikolaou, K, Ulimoen, G, Zhang, Z, Mickley, H, Nieman, K, Kaufmann, P, Büchel, RR, Herzog, B, Clouse, M, Halon, DA, Leipsic, J, Bush, D, Jakamy, R, Sun, K, Yang, L, Johnson, T, Laissy, JP, Marcus, R, Muraglia, S, Tardif, JC, Chow, B, Paul, N, Maintz, D, Hoe, J, de Roos, A, Haase, R, Laule, M, Schlattmann, P & Dewey, M 2018, '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', European Radiology, pp. 1-12. https://doi.org/10.1007/s00330-018-5322-5
Roehle, Robert ; Wieske, Viktoria ; Schuetz, Georg M. ; Gueret, Pascal ; Andreini, Daniele ; Meijboom, Willem Bob ; Pontone, Gianluca ; Garcia, Mario J. ; Alkadhi, Hatem ; Honoris, Lily ; Hausleiter, Jörg ; Bettencourt, Nuno ; Zimmermann, Elke ; Leschka, Sebastian ; Gerber, Bernhard ; Rochitte, Carlos ; Schoepf, U. Joseph ; Shabestari, Abbas Arjmand ; Nørgaard, Bjarne ; Sato, Akira ; Knuuti, Juhani ; Meijs, Matthijs F.L. ; Brodoefel, Harald ; Jenkins, Shona M.M. ; Øvrehus, Kristian Altern ; Diederichsen, Axel Cosmus Pyndt ; Hamdan, Ashraf ; Halvorsen, Bjørn Arild ; Mendoza Rodriguez, Vladimir ; Wan, Yung Liang ; Rixe, Johannes ; Sheikh, Mehraj ; Langer, Christoph ; Ghostine, Said ; Martuscelli, Eugenio ; Niinuma, Hiroyuki ; Scholte, Arthur ; Nikolaou, Konstantin ; Ulimoen, Geir ; Zhang, Zhaoqi ; Mickley, Hans ; Nieman, Koen ; Kaufmann, Philipp ; Büchel, Ronny Ralf ; Herzog, Bernhard ; Clouse, Melvin ; Halon, David A. ; Leipsic, Jonathan ; Bush, David ; Jakamy, Reda ; Sun, Kai ; Yang, Lin ; Johnson, Thorsten ; Laissy, Jean Pierre ; Marcus, Roy ; Muraglia, Simone ; Tardif, Jean Claude ; Chow, Benjamin ; Paul, Narinder ; Maintz, David ; Hoe, John ; de Roos, Albert ; Haase, Robert ; Laule, Michael ; Schlattmann, Peter ; Dewey, Marc. / 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. In: European Radiology. 2018 ; pp. 1-12.
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abstract = "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.",
keywords = "Coronary artery disease, Duke clinical score, Multidetector computed tomography, NICE clinical guideline, Pretest probability",
author = "Robert Roehle and Viktoria Wieske and Schuetz, {Georg M.} and Pascal Gueret and Daniele Andreini and Meijboom, {Willem Bob} and Gianluca Pontone and Garcia, {Mario J.} and Hatem Alkadhi and Lily Honoris and J{\"o}rg Hausleiter and Nuno Bettencourt and Elke Zimmermann and Sebastian Leschka and Bernhard Gerber and Carlos Rochitte and Schoepf, {U. Joseph} and Shabestari, {Abbas Arjmand} and Bjarne N{\o}rgaard and Akira Sato and Juhani Knuuti and Meijs, {Matthijs F.L.} and Harald Brodoefel and Jenkins, {Shona M.M.} and {\O}vrehus, {Kristian Altern} and Diederichsen, {Axel Cosmus Pyndt} and Ashraf Hamdan and Halvorsen, {Bj{\o}rn Arild} and {Mendoza Rodriguez}, Vladimir and Wan, {Yung Liang} and Johannes Rixe and Mehraj Sheikh and Christoph Langer and Said Ghostine and Eugenio Martuscelli and Hiroyuki Niinuma and Arthur Scholte and Konstantin Nikolaou and Geir Ulimoen and Zhaoqi Zhang and Hans Mickley and Koen Nieman and Philipp Kaufmann and B{\"u}chel, {Ronny Ralf} and Bernhard Herzog and Melvin Clouse and Halon, {David A.} and Jonathan Leipsic and David Bush and Reda Jakamy and Kai Sun and Lin Yang and Thorsten Johnson and Laissy, {Jean Pierre} and Roy Marcus and Simone Muraglia and Tardif, {Jean Claude} and Benjamin Chow and Narinder Paul and David Maintz and John Hoe and {de Roos}, Albert and Robert Haase and Michael Laule and Peter Schlattmann and Marc Dewey",
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month = "3",
day = "19",
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T1 - 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

AU - Roehle, Robert

AU - Wieske, Viktoria

AU - Schuetz, Georg M.

AU - Gueret, Pascal

AU - Andreini, Daniele

AU - Meijboom, Willem Bob

AU - Pontone, Gianluca

AU - Garcia, Mario J.

AU - Alkadhi, Hatem

AU - Honoris, Lily

AU - Hausleiter, Jörg

AU - Bettencourt, Nuno

AU - Zimmermann, Elke

AU - Leschka, Sebastian

AU - Gerber, Bernhard

AU - Rochitte, Carlos

AU - Schoepf, U. Joseph

AU - Shabestari, Abbas Arjmand

AU - Nørgaard, Bjarne

AU - Sato, Akira

AU - Knuuti, Juhani

AU - Meijs, Matthijs F.L.

AU - Brodoefel, Harald

AU - Jenkins, Shona M.M.

AU - Øvrehus, Kristian Altern

AU - Diederichsen, Axel Cosmus Pyndt

AU - Hamdan, Ashraf

AU - Halvorsen, Bjørn Arild

AU - Mendoza Rodriguez, Vladimir

AU - Wan, Yung Liang

AU - Rixe, Johannes

AU - Sheikh, Mehraj

AU - Langer, Christoph

AU - Ghostine, Said

AU - Martuscelli, Eugenio

AU - Niinuma, Hiroyuki

AU - Scholte, Arthur

AU - Nikolaou, Konstantin

AU - Ulimoen, Geir

AU - Zhang, Zhaoqi

AU - Mickley, Hans

AU - Nieman, Koen

AU - Kaufmann, Philipp

AU - Büchel, Ronny Ralf

AU - Herzog, Bernhard

AU - Clouse, Melvin

AU - Halon, David A.

AU - Leipsic, Jonathan

AU - Bush, David

AU - Jakamy, Reda

AU - Sun, Kai

AU - Yang, Lin

AU - Johnson, Thorsten

AU - Laissy, Jean Pierre

AU - Marcus, Roy

AU - Muraglia, Simone

AU - Tardif, Jean Claude

AU - Chow, Benjamin

AU - Paul, Narinder

AU - Maintz, David

AU - Hoe, John

AU - de Roos, Albert

AU - Haase, Robert

AU - Laule, Michael

AU - Schlattmann, Peter

AU - Dewey, Marc

PY - 2018/3/19

Y1 - 2018/3/19

N2 - 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.

AB - 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.

KW - Coronary artery disease

KW - Duke clinical score

KW - Multidetector computed tomography

KW - NICE clinical guideline

KW - Pretest probability

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