 previous article in this issue | next article in this issue  |
|
Document Details : Title: Why does the general practitioner refer patients with chest pain not-urgently to the specialist or urgently to the emergency department? Subtitle: Influence of the certainty of the initial diagnosis Author(s): R. Bruyninckx , A. Van Den Bruel , B. Aertgeerts , V. Van Casteren , F. Buntinx Journal: Acta Cardiologica Volume: 64 Issue: 2 Date: 2009 Pages: 259-265 DOI: 10.2143/AC.64.2.2036147 Abstract : Background — Chest pain is an initial symptom for several minor diseases but acute myocardial infarction (AMI) should not be missed. Aim — To assess the influence of initial diagnosis and degree of certainty of this initial diagnosis on the referral decision and the referral method (urgent – non-urgent) in patients contacting their GP with chest pain. Study design — Observational study. Setting — The study was performed in a sentinel network of general practices in Belgium, covering almost 1.6% of the population. Subjects — All patients attending their GP and complaining of chest pain during 2003. Method — The relationships were reported as proportions and in odds ratios (OR) with their 95% confidence intervals. Results — 1996 patients were included (men 52%). Men were referred more often (OR = 1.44; 95% CI: 1.13-1.82). Age shows no relation to referral (OR = 1.06; 95% CI: 0.83-1.35) but predicts urgent referral (OR = 1.46; 95% CI: 1.02-2.08). Odds ratios in case of serious heart disease were high with 11.58 (95% CI: 5.72-23.44) when the GP was certain of his diagnosis and 2.96 (95% CI: 1.59-5.51) if not. If the GP was uncertain, in all disease categories 54% (95% CI: 48-59) of the patients were referred non-urgently. Conclusion — Referral rates for patients with chest pain were influenced by the initial diagnosis and the degree of certainty of this initial diagnosis. |
