Why does the general practitioner refer patients with chest pain not-urgently to the specialist or urgently to the emergency department? Influence of the certainty of the initial diagnosis
Bruyninckx R., Van Den Bruel A., Aertgeerts B., Van Casteren V., Buntinx F.
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% Cl: 1.13-1.82). Age shows no relation to referral (OR= 1.06; 95% Cl: 0.83-1.35) but predicts urgent referral (OR = 1.46; 95% Cl: 1.02-2.08). Odds ratios in case of serious heart disease were high with 11.58 (95% Cl: 5.72-23.44) when the GP was certain of his diagnosis and 2.96 (95% Cl: 1.59-5.51) if not. If the GP was uncertain, in all disease categories 54% (95% Cl: 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.