Table 2 Summary of diagnostic accuracy of tests used in non-cardiac chest pain

Symptoms

Kim et al. [24]

NCCP with atypical GERD symptoms

Endoscopy (LA classification) and/or 24 h pH-metry (>4%, pH <4

24

0.49

2.71

Kim et al. [24]

NCCP with typical GERD symptoms

Same

67

2.75

0.42

Mousavi et al. [27]

NCCP with typical GERD symptoms

GERD if two tests positive: endoscopy (Hentzel-Dent), Bernstein test, omeprazole trial

45

2.70

0.78

Mousavi et al. [27]

NCCP relieved by antacid

Same

45

0.51

3.51

Mousavi et al. [27]

NCCP and heartburn in past history

Same

45

2.15

0.74

Mousavi et al. [27]

NCCP and regurgitation in past history

Same

45

2.98

0.61

Hong et al. [25]

NCCP

Manometry (Specler 2001 criteria) and/or 24 h pH-metry (>4% pH <4)

43

0.83

1.13

Hong et al. [25]

Control: dysphagia

Same

45

1.27

0.97

Hong et al. [25]

Control: GERD-typical symptoms

Same

44

1.26

0.93

Netzer et al. [26]

NCCP

Manometry and/or 24 h pH-metry (>10.5% pH <4)

84

0.43

1.23

Netzer et al. [26]

Control: GERD-typical symptoms

Same

84

1.53

0.74

Netzer et al. [26]

Control: dysphagia

Same

84

1.16

0.97

Proton pump inhibitor (PPI) trial

Dickman et al. [31]

Rabeprazole 20 mg twice a day for 1 week SIS ≥50%

Endoscopy (Hentzel-Dent grades) and/or 24 h pH-metry (>4.2% pH <4)

46

7.13

0.28

Dickman et al. [31]

Placebo for 1 week

Same

46

0.89

1.03

Bautista et al. [32]

Lansoprazole 60 mg AM, 30 mg PM for 1 week SIS ≥50%

Endoscopy (Hentzel-Dent grades) and/or 24 h pH-metry (>4.2% pH <4)

45

8.56

0.24

Bautista et al. [32]

Lansoprazole 60 mg AM, 30 mg PM for 1 week SIS ≥65%

Same

45

18.33

0.17

Bautista et al. [32]

Placebo for 1 week

Same

45

0.61

1.22

Fass et al. [33]

Omeprazole 40 mg AM, 20 mg PM for 1 week SIS ≥50%

Endoscopy (Hentzel-Dent grades) and/or 24 h pH-metry (>4.2% pH <4)

62

5.48

0.25

Fass et al. [33]

Placebo for 1 week

Same

62

3.04

0.84

Pandak et al. [34]

Omeprazole 40 mg twice a day for 2 weeks SIS ≥50%

Endoscopy and/or 24 h pH-metry (>4.2% pH <4)

53

2.70

0.15

Pandak et al. [34]

Placebo for 2 weeks SIS ≥50%

Same

53

0.30

1.14

Kim et al. [35]

NCCP rabeprazole for 1 week SIS ≥50%

Endoscopy (LA classification) and/or 24 h pH-metry (>4.0 pH <4)

38

2.17

0.65

Kim et al. [35]

NCCP rabeprazole for 2 weeks SIS ≥50%

Same

38

3.02

0.26

Xia et al. [36]

Lansoprazole 30 mg once a day for 4 weeks SIS ≥50%

24 h pH-metry (De Meester pH <4, 7.5 s)

33

2.75

0.13

Xia et al. [36]

Placebo for 4 weeks SIS ≥50%

Same

38

0.95

1.03

Kushnir et al. [37]

High-degree response on PPI (not specified)

24 pH-metry (≥4%, pH <4)

53

1.97

0.38

Provocation test

Cooke et al. [39]

NCCP during exertional pH-metry

24 h pH-metry (5.5% pH <4 for 10 s)

38

14.40

0.79

Cooke et al. [39]

Control group: CVD with angina: exertional pH-metry

Same

19

4.33

0.72

Bovero et al. [40]

NCCP with normal ECG during exertional pH-metry

24 h pH-metry (De Meester criteria: >4.5% pH <4))

69

7.76

0.66

Bovero et al. [40]

NCCP at rest: NCCP with normal ECG during exertional pH-metry

Same

74

3.88

0.74

Bovero et al. [40]

NCCP exertion/mixed: NCCP with normal ECG during exertional pH-metry

Same

57

10.00

0.50

Romand et al. [41]

NCCP: pH <4 for 10 s during exertional pH-metry

24 h pH-metry (De Meester criteria: >4.5% pH <4))

23

1.65

0.52

Abrahao et al. [42]

NCCP reproducible during balloon distension

Endoscopy (Savary-Miller) and/or manometry and/or pH-metry (De Meester criteria: >4.5% pH <4

88

2.00

0.75

Abrahao et al. [42]

NCCP reproducible during Tensilon test

Same

88

0.43

1.38

Abrahao et al. [42]

NCCP reproducible during Bernstein test

Same

88

1.29

0.93

Abrahao et al. [42]

Tensilon and Bernstein Test and balloon distension (+ if 1 test +)

Same

88

0.95

1.07

Ho et al. [29]

NCCP reproducible during Bernstein test

24 h pH-metry (>4% pH <4, 4 s)

23

0.75

1.06

Musculoskeletal disorders

Stochkendahl et al. [44]

≥3 of 5 palpation findings: (1) sitting motion of end-play restriction in lateral flexion and rotation segment C4 to C7 and Th1 to Th8. (2) Prone motion joint-play restriction segment Th1 to Th8. (3) Prone evaluation paraspinal tenderness segment Th1 to Th8. (4) Supine manual palpation muscular tenderness of 14 points anterior chest wall. 5) Supine evaluation of tenderness of the costosternal junctions of costa 2 to 6 and xiphoid process

Diagnosis using a standardized examination protocol:

37

1.52

0.03

(1) A semistructured interview: pain characteristics, lung and gastrointestinal symptoms, past medical history, height, weight, cardiovascular risk factors

(2) A general health examination: blood pressure, pulse, heart and lung stethoscopy, abdominal palpation, neck auscultation, signs of left ventricular failure, neurological examination

(3) Manual examination of the muscles and joints (neck, thoracic spine and thorax): active range of motion, manual palpation 14 points muscular tenderness of the anterior chest wall and segmental paraspinal muscles, motion palpation for joint-play restriction of the thoracic spine (Th1 to 8), and end play restriction of the cervical and thoracic spine

Bosner et al. [45]

Chest wall symptom (CWS) score: localized muscle tension, stinging pain, pain reproducible by palpation, absence of cough

Interdisciplinary consensus: cardiologist, GP, research associate (based on reviewed baseline, follow-up data at 6 weeks and 6 months)

47

1.82

0.20

Cut-off test negative 0 to 1 points

Bosner et al. [45]

CWS score: localized muscle tension, stinging pain, pain reproducible by palpation, absence of cough

Interdisciplinary consensus

47

3.02

0.47

Cut-off test negative 0 to 2 points

Stochkendahl et al. [44]

Biomechanical dysfunction (part of the standardized examination protocol)^a

Standardized examination protocol

37

1.58

0.00

Stochkendahl et al. [44]

Anterior chest wall tenderness

Standardized examination protocol

37

1.39

0.06

Stochkendahl et al. [44]

Angina pectoris (uncertain or negative)

Standardized examination protocol

37

1.26

0.12

Stochkendahl et al. [44]

Pain worse on movement of torso

Standardized examination protocol

37

3.39

0.78

Bosner et al. [45]

Pain worse with movement

Interdisciplinary consensus

47

2.13

0.75

Stochkendahl et al. [44]

Positive/possible belief in pain origin from muscle/joints

Standardized examination protocol

37

1.17

0.20

Stochkendahl et al. [44]

Pain relief on pain medication

Standardized examination protocol

37

3.26

0.83

Bosner et al. [45]

Pain reproducible by palpation

Interdisciplinary consensus

47

2.08

0.54

Stochkendahl et al. [44]

Paraspinal tenderness

Standardized examination protocol

37

1.36

0.48

Bosner et al. [45]

Localized muscle tension

Interdisciplinary consensus

47

2.41

0.52

Stochkendahl et al. [44]

Chest pain present now

Standardized examination protocol

37

1.35

0.46

Bosner et al. [45]

Pain now

Interdisciplinary consensus

47

1.15

0.85

Stochkendahl et al. [44]

Pain debut not during a meal

Standardized examination protocol

37

1.10

0.23

Stochkendahl et al. [44]

Sharp pain

Standardized examination protocol

37

1.89

0.80

Bosner et al. [45]

Stinging pain

Interdisciplinary consensus

47

1.87

0.66

Stochkendahl et al. [44]

Hard physical exercise at least once a week

Standardized examination protocol

37

1.19

0.91

Stochkendahl et al. [44]

Pain not provoked during a meal

Standardized examination protocol

37

1.09

0.25

Stochkendahl et al. [44]

Not sudden debut

Standardized examination protocol

37

2.90

0.63

Bosner et al. [45]

Pain >24 h

Interdisciplinary consensus

47

1.30

0.92

Stochkendahl et al. [44]

Age ≤49 years old

Standardized examination protocol

37

2.10

0.56

Bosner et al. [45]

Pain mostly at noon time

Interdisciplinary consensus

47

0.50

1.02

Bosner et al. [45]

Cough

Interdisciplinary consensus

47

0.28

1.18

Bosner et al. [45]

Known IHD

Interdisciplinary consensus

47

0.52

1.11

Bosner et al. [45]

Pain worse with breathing

Interdisciplinary consensus

47

1.28

0.93

Psychiatric diseases

Kuijpers et al. [47]

Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A score, cut-off ≥8)

Diagnosis anxiety disorders (Mini International Neuropsychiatric Interview (gold standard))

58

2.03

0.03

Demiryoguran et al. [48]

Chills or hot flushes

Anxiety disorder: HADS-A score (cut-off ≥10)

31

4.85

0.81

Demiryoguran et al. [48]

Fear of dying

Anxiety disorder: HADS-A score (cut-off ≥10)

31

4.04

0.82

Demiryoguran et al. [48]

Diaphoresis

Anxiety disorder: HADS-A score (cut-off ≥10)

31

3.49

0.69

Demiryoguran et al. [48]

Light-headedness, dizziness, faintness

Anxiety disorder: HADS-A score (cut-off ≥10)

31

3.03

0.84

Demiryoguran et al. [48]

Palpitation

Anxiety disorder: HADS-A score (cut-off ≥10)

31

1.54

0.83

Demiryoguran et al. [48]

Shortness of breath

Anxiety disorder: HADS-A score (cut-off ≥10)

31

1.30

0.92

Demiryoguran et al. [48]

Nausea or gastric discomfort

Anxiety disorder: HADS-A score (cut-off ≥10)

31

1.98

0.90

Foldes-Busque et al. [49]

The Panic Screening Score (derivation population); does the patient have a history of anxiety disorders? Please indicate how often this thought occurs when you are nervous: ‘I will choke to death’. Did the patient arrive in the ED by ambulance? Please answer the statement by circling the number that best applies to you: ‘When I notice my heart beating rapidly, I worry that I might be having a heart attack’. Sum score 22, A total score ≥6 indicates probable panic.

Panic disorder Diagnosis (structured Anxiety Disorders Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (ADIS-IV))

42

3.89

0.44

Foldes-Busque et al. [49]

The Panic Screening Score (validation population).

Panic disorder diagnosis (structured ADIS-IV)

43

3.44

0.55

Fleet et al. [50]

Panic disorder diagnosis: formula including Agoraphobia Cognitions QA, Mobility Inventory for Agoraphobia, Zone 12 Dermatome Pain Map, Sensory McGill Pain QA, Gender, Zone 25 (validation population)

Panic disorder (ADIS-R structured interview by psychologist)

23

2.60

0.46

Katerndahl et al. [51]

GP diagnosis of panic disorder

Panic disorder (structured clinical interview of Diagnostic and Statistical Manual of Mental Disorders, based on DSM-III-R)

55

0.82

1.02