Chest pain in general practice: a systematic review of prediction rules

Typically, in the ER setting there are a slew of tools a clinician can use to assess the severity of a patient’s chest pain. These clinical decision rules (CDRs), such as the heart score depend on certain evaluations that can only be done in the ED, for example a troponin level. In family practice drawing bloodwork for such labs would be inappropriate. Considering this several CDRs exist for chest pain. Such rules are incredibly useful for general practitioners but are they efficacious? Harskamp et al conducted an international systematic review of several clinical prediction/decision rules. They investigated three CDRs for assessing coronary disease type intermittent chest pain. These were the Gencer rule, Marburg Heart Score, and INTERCHEST. Of these three rules the Marburg heart score was consistently sensitive and specific for identifying the presence of chest pain secondary to coronary disease. Compared to the other two rules, the Marburg heart score had a better positive predictor value and had greater diagnostic performance. In all, this systematic review suggests that utilization of the Marburg decision rule can outperform clinical judgment when dealing with intermittent chest pain.