Haasenritter Jörg, Biroga Tobias, Keunecke Christian, Becker Annette, Donner-Banzhoff Norbert, Dornieden Katharina, Stadje Rebekka, Viniol Annika, Bösner Stefan
Jörg Haasenritter, Philipps University of Marburg, Department of General Practice/Family Medicine, Karl-von-Frisch-Str. 4, 35043 Marburg, Germany,
Croat Med J. 2015 Oct;56(5):422-30. doi: 10.3325/cmj.2015.56.422.
To investigate the frequencies of different and relevant underlying etiologies of chest pain in general practice.
We systematically searched PubMed and EMBASE. Two reviewers independently rated the eligibility of publications and assessed the risk of bias of included studies. We extracted data to calculate the relative frequencies of different underlying conditions and investigated the variation across studies using forest plots, I(2), tau(2), and prediction intervals. With respect to unexplained heterogeneity, we provided qualitative syntheses instead of pooled estimates.
We identified 11 eligible studies comprising about 6500 patients. The overall risk of bias was rated as low in 6 studies comprising about 3900 patients. The relative frequencies of different conditions as the underlying etiologies of chest pain reported by these studies ranged from 24.5 to 49.8% (chest wall syndrome), 13.8 to 16.1% (cardiovascular diseases), 6.6 to 11.2% (stable coronary heart disease), 1.5 to 3.6% (acute coronary syndrome/myocardial infarction), 10.3 to 18.2% (respiratory diseases), 9.5 to 18.2% (psychogenic etiologies), 5.6 to 9.7% (gastrointestinal disorders), and 6.0 to 7.1% (esophageal disorders).
This information may be of practical value for general practitioners as it provides the pre-test probabilities for a range of underlying diseases and may be suitable to guide the diagnostic process.
调查全科医疗中胸痛不同相关潜在病因的发生频率。
我们系统检索了PubMed和EMBASE。两名评审员独立评定出版物的合格性，并评估纳入研究的偏倚风险。我们提取数据以计算不同潜在疾病的相对频率，并使用森林图、I²、τ²和预测区间研究各研究间的差异。对于无法解释的异质性，我们提供定性综合分析而非合并估计值。
我们确定了11项合格研究，共纳入约6500例患者。在约3900例患者的6项研究中，总体偏倚风险被评为低。这些研究报告的作为胸痛潜在病因的不同疾病的相对频率范围为：胸壁综合征24.5%至49.8%、心血管疾病13.8%至16.1%、稳定型冠心病6.6%至11.2%、急性冠状动脉综合征/心肌梗死1.5%至3.6%、呼吸系统疾病10.3%至18.2%、心因性病因9.5%至18.2%、胃肠道疾病5.6%至9.7%、食管疾病6.0%至7.1%。
该信息可能对全科医生具有实际价值，因为它提供了一系列潜在疾病的检验前概率，可能适用于指导诊断过程。
