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Family Practice Vol. 9, No. 2, 149-153
© Oxford University Press 1992

research-article

Evaluating Patients with Chest Pain Using Classification and Regression Trees

F BUNTINX*,{dagger},, J TRUYEN*, P EMBRECHTS§, G MOREEL§ and R PEETERS*

Catholic University Leuven Belgium
*Flemish Institute of General Practice State University of Limburg Maastricht, Netherlands
{dagger}Department of General Practice, State University of Limburg Maastricht, Netherlands
§Limburg University Center Diepenbeck, Belgium

Correspondence address: Dr. F. Buntinx, Dr. Haubenlaan 43, B-3630 Maasmechelen, Belgium

We collected data on 320 patients complaining to their general practitioner of a new episode of chest pain, discomfort or oppression. Relationships were examined between initial signs and symptoms and a follow-up diagnosis after a period of 2 weeks to 2 months. The data were analysed with CART, a statistical decision theory software package. In our first run, the number of misclassifications by CART was 56%. After regrouping of the data and diagnostic categories, there were 37% misclassifications. The most discriminating variable turned out to be pain on palpation. When comparing each of five diagnostic groups to all others, we found a positive predictive value of 27% for gastrointestinal diseases, 72% for cardiovascular disorders, 69% for respiratory diseases, 58% for psychopathology and 73% for chest wall pathology. The CART methodology needs further investigation and testing before any clinical application will be possible in general practice.


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