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 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; 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 A. Kaufmann; Ronny Ralf Buechel; Bernhard A. 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

doi:10.1007/s00330-018-5322-5

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 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 SatoJuhani 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 A. Kaufmann, Ronny Ralf Buechel, Bernhard A. 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

Medicine

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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.

Original language	English (US)
Pages (from-to)	4006-4017
Number of pages	12
Journal	European Radiology
Volume	28
Issue number	9
DOIs	https://doi.org/10.1007/s00330-018-5322-5
State	Published - Sep 1 2018

Keywords

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

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

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10.1007/s00330-018-5322-5

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Roehle, R., Wieske, V., Schuetz, G. M., Gueret, P., Andreini, D., Meijboom, W. B., Pontone, G., Garcia, M., Alkadhi, H., Honoris, L., Hausleiter, J., Bettencourt, N., Zimmermann, E., Leschka, S., Gerber, B., Rochitte, C., Schoepf, U. J., Shabestari, A. A., Nørgaard, B., ... 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, 28(9), 4006-4017. https://doi.org/10.1007/s00330-018-5322-5

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. et al.
In: European Radiology, Vol. 28, No. 9, 01.09.2018, p. 4006-4017.

Research output: Contribution to journal › Article › peer-review

Roehle, R, Wieske, V, Schuetz, GM, Gueret, P, Andreini, D, Meijboom, WB, Pontone, G, Garcia, M, 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, PA, Buechel, RR, Herzog, BA, 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, vol. 28, no. 9, pp. 4006-4017. https://doi.org/10.1007/s00330-018-5322-5

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title = "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",

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 Mario Garcia 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 Kaufmann, {Philipp A.} and Buechel, {Ronny Ralf} and Herzog, {Bernhard A.} 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",

note = "Funding Information: JH reports grants from Siemens Medical Solutions, outside the submitted work. UJS reports grants from Bayer, grants from Bracco, grants from GE, grants from Medrad, grants from Siemens Healthcare, outside the submitted work. JK reports personal fees from Lantheus Inc, grants from Orion Pharma, outside the submitted work. KN reports non-financial support from Siemens Medical Solutions, grants from GE Healthcare, other from Toshiba Medical Systems, non-financial support from Abbott Vascular, grants from Bayer healthcare, outside the submitted work. PK, RRB, and BH report that the University Hospital Zurich holds a research contract with GE Healthcare. JL reports personal fees from GE Healthcare, personal fees from Heartflow, outside the submitted work. BC reports research grants from GE healthcare and educational support from TeraRecon, outside the submitted work. NP reports grants from Toshiba Medical System, outside the submitted work. JH reports grants and personal fees from Toshiba Medical Systems, during the conduct of the study. RH reports grants from Toshiba, outside the submitted work. PS reports grants from Ministry of Education and Research (BMBF) for meta-analyses as part of the joint programme {"}clinical trials{"} of the BMBF and the German Science Foundation (DFG), during the conduct of the study; grants from German Science Foundation (DFG), grants from European Union, outside the submitted work. MD has received grant support from the Heisenberg Program of the DFG for a professorship (DE 1361/14-1), the FP7 Program of the European Commission for the randomized multicentre DISCHARGE trial (603266-2, HEALTH-2012.2.4.-2), the European Regional Development Fund (20072013 2/05, 20072013 2/48), the German Heart Foundation/German Foundation of Heart Research (F/23/08, F/27/10), the Joint Program from the German Research Foundation (DFG) and the German Federal Ministry of Education and Research (BMBF) for meta-analyses (01KG1013, 01KG1110, 01KG1110) Funding Information: Funding The authors of this manuscript state that the CoMe-CCT project received funding from the joint program of the German Research Foundation (DFG) and the German Federal Ministry of Education and Research (BMBF) for meta-analyses. Publisher Copyright: {\textcopyright} 2018, European Society of Radiology.",

year = "2018",

month = sep,

day = "1",

doi = "10.1007/s00330-018-5322-5",

language = "English (US)",

volume = "28",

pages = "4006--4017",

journal = "European Radiology",

issn = "0938-7994",

publisher = "Springer Verlag",

number = "9",

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TY - JOUR

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

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 A.

AU - Buechel, Ronny Ralf

AU - Herzog, Bernhard A.

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

N1 - Funding Information: JH reports grants from Siemens Medical Solutions, outside the submitted work. UJS reports grants from Bayer, grants from Bracco, grants from GE, grants from Medrad, grants from Siemens Healthcare, outside the submitted work. JK reports personal fees from Lantheus Inc, grants from Orion Pharma, outside the submitted work. KN reports non-financial support from Siemens Medical Solutions, grants from GE Healthcare, other from Toshiba Medical Systems, non-financial support from Abbott Vascular, grants from Bayer healthcare, outside the submitted work. PK, RRB, and BH report that the University Hospital Zurich holds a research contract with GE Healthcare. JL reports personal fees from GE Healthcare, personal fees from Heartflow, outside the submitted work. BC reports research grants from GE healthcare and educational support from TeraRecon, outside the submitted work. NP reports grants from Toshiba Medical System, outside the submitted work. JH reports grants and personal fees from Toshiba Medical Systems, during the conduct of the study. RH reports grants from Toshiba, outside the submitted work. PS reports grants from Ministry of Education and Research (BMBF) for meta-analyses as part of the joint programme "clinical trials" of the BMBF and the German Science Foundation (DFG), during the conduct of the study; grants from German Science Foundation (DFG), grants from European Union, outside the submitted work. MD has received grant support from the Heisenberg Program of the DFG for a professorship (DE 1361/14-1), the FP7 Program of the European Commission for the randomized multicentre DISCHARGE trial (603266-2, HEALTH-2012.2.4.-2), the European Regional Development Fund (20072013 2/05, 20072013 2/48), the German Heart Foundation/German Foundation of Heart Research (F/23/08, F/27/10), the Joint Program from the German Research Foundation (DFG) and the German Federal Ministry of Education and Research (BMBF) for meta-analyses (01KG1013, 01KG1110, 01KG1110) Funding Information: Funding The authors of this manuscript state that the CoMe-CCT project received funding from the joint program of the German Research Foundation (DFG) and the German Federal Ministry of Education and Research (BMBF) for meta-analyses. Publisher Copyright: © 2018, European Society of Radiology.

PY - 2018/9/1

Y1 - 2018/9/1

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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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

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