Wang CS, et al. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA. 2005 Oct 19;294(15):1944-56.
Objective: Assess the usefulness of exam, including routine diagnostic studies, such as serum B-type natriuretic peptide [BNP], that differentiate heart failure from other causes of dyspnea in the emergency department. Includes
♦Searched MEDLINE (1966-July 2005) and the reference lists from retrieved articles, previous reviews, and physical examination textbooks
♦2 authors independently abstracted data and assessed methodological quality
♦Specifically excluded studies with convenience samples including patients who obviously had the disease and studies with unvalidated reference standard in convenience samples
11 studies (N=3,302) evaluated cutoffs of serum BNP in diagnosing heart failure in the emergency department.
Table 5 shows the pooled sensitivities, specificities and likelihood ratios of various cutoffs.
In patients with a prior history of asthma or COPD:
Table 6 shows the sensitivities, specificities, and likelihood ratios for various findings from subgroup analysis of large prospective study included in meta-analysis above.
For BNP≥100pg/mL in these patients: sensitivity=0.93, specifity=0.77, positive LR=4.1 (CI, 3.5-5.0) and negative LR=0.09 (CI, 0.04-0.19)