Abstract, accepted for oral presentation at the EGPRN conference (Tampere, Finland, 2019)

by Marie Barais.

Background. Dyspnoea and chest pain are symptoms shared with multiple pathologies ranging from the benign to life-threatening diseases. Gut feelings such as the sense of alarm and the sense of reassurance play a substantial role in the diagnostic reasoning process of general practitioners (GPs), also in the case of dyspnoea and chest pain. A validated Gut Feelings Questionnaire (GFQ) enables us to determine the presence or absence of a GP’s sense of alarm or sense of reassurance.

Research question. The aim of the study was to estimate the diagnostic test accuracy of GPs’ sense of alarm distinguishing life and non-life-threatening pathologies when confronted with dyspnoea and chest pain.

Methods. Prospective observational study in general practice. Patients aged between 18 and 80 years, consulting their GP for dyspnoea and/or chest pain, were considered for enrolment. These GPs had to complete the GFQ immediately after the consultation. Life-threatening and non-life-threatening diseases have previously been defined according to the pathologies or symptoms in the ICPC2 classification following a nominal group procedure. The index test was the sense of alarm and the reference standard was the final diagnosis at 4 weeks.

Results. 25 GPs filled in 235 GFQ questionnaires. The positive likelihood ratio for the sense of alarm was 2.12 [CI95 = 1.49; 2.82], the negative likelihood ratio was 0.55 [CI95 = 0.37; 0.77]. When a GP experienced a sense of alarm when a patient consulted him/her for dyspnoea and/or chest pain, the post-test odds that this patient has, in fact, a life-threatening disease was about twice as high as the pre-test odds.

Conclusions. The sense of alarm is valuable in the context of low-level signs of diseases related to dyspnoea and chest pain.