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Pooled individual patient data from five countries were used to derive a clinical prediction rule for coronary artery disease in primary care.

Aerts, Marc (författare)
Interuniversity Institute for Biostatistics and Statistical Bioinformatics
Minalu, Girma (författare)
Interuniversity Institute for Biostatistics and Statistical Bioinformatics
Bösner, Stefan (författare)
Department of General Practice and Family Medicine, Philipps University Marburg, Germany.
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Buntinx, Frank (författare)
Department of Public Health and Primary Care, KU Leuven, Belgium; Department of General Practice, Maastricht University, The Netherlands.
Burnand, Bernard (författare)
Institute of Social and Preventive Medicine, Lausanne University Hospital, Switzerland.
Haasenritter, Jörg (författare)
Department of General Practice and Family Medicine, Philipps University Marburg, Germany.
Herzig, Lilli (författare)
Institute of Family Medicine, University of Lausanne, Switzerland.
Knottnerus, J André (författare)
Department of General Practice, Maastricht University, The Netherlands.
Nilsson, Staffan (författare)
Linköpings universitet,Avdelningen för samhällsmedicin,Medicinska fakulteten,Region Östergötland, Vårdcentralen Vikbolandet
Renier, Walter (författare)
Department of Public Health and Primary Care, KU Leuven, Belgium
Sox, Carol (författare)
Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, USA.
Sox, Harold (författare)
Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH , USA; Patient-Centered Outcomes Research Institute, Washington, USA.
Donner-Banzhoff, Norbert (författare)
Department of General Practice and Family Medicine, Philipps University Marburg, Germany.
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Interuniversity Institute for Biostatistics and Statistical Bioinformatics Department of General Practice and Family Medicine, Philipps University Marburg, Germany (creator_code:org_t)
Elsevier, 2017
2017
Engelska.
Ingår i: Journal of Clinical Epidemiology. - : Elsevier. - 0895-4356 .- 1878-5921. ; 81, s. 120-128
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
Stäng  
  • OBJECTIVE: To construct a clinical prediction rule for coronary artery disease (CAD) presenting with chest pain in primary care.STUDY DESIGN AND SETTING: Meta-Analysis using 3,099 patients from five studies. To identify candidate predictors, we used random forest trees, multiple imputation of missing values, and logistic regression within individual studies. To generate a prediction rule on the pooled data, we applied a regression model that took account of the differing standard data sets collected by the five studies.RESULTS: The most parsimonious rule included six equally weighted predictors: age ≥55 (males) or ≥65 (females) (+1); attending physician suspected a serious diagnosis (+1); history of CAD (+1); pain brought on by exertion (+1); pain feels like "pressure" (+1); pain reproducible by palpation (-1). CAD was considered absent if the prediction score is <2. The area under the ROC curve was 0.84. We applied this rule to a study setting with a CAD prevalence of 13.2% using a prediction score cutoff of <2 (i.e., -1, 0, or +1). When the score was <2, the probability of CAD was 2.1% (95% CI: 1.1-3.9%); when the score was ≥ 2, it was 43.0% (95% CI: 35.8-50.4%).CONCLUSIONS: Clinical prediction rules are a key strategy for individualizing care. Large data sets based on electronic health records from diverse sites create opportunities for improving their internal and external validity. Our patient-level meta-analysis from five primary care sites should improve external validity. Our strategy for addressing site-to-site systematic variation in missing data should improve internal validity. Using principles derived from decision theory, we also discuss the problem of setting the cutoff prediction score for taking action.

Ämnesord

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskaper -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Cardiac and Cardiovascular Systems (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Kardiologi (hsv//swe)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)
MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskaper (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)
MEDICAL AND HEALTH SCIENCES  -- Health Sciences (hsv//eng)

Nyckelord

Chest pain
Individual patient data meta-analysis
Medical history taking
Myocardial ischemia
Primary health care
Sensitivity and specificity
Symptom assessment

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