Open AccessEffect of NT ‐pro‐ BNP Assay on Accuracy and Confidence of General Practitioners in Diagnosing Heart Failure or Respiratory Disease in Cats with Respiratory Signs
Author(s) -
Singletary G.E.,
Rush J.E.,
Fox P.R.,
Stepien R.L.,
Oyama M.A.
Publication year - 2012
Publication title -
journal of veterinary internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.356
H-Index - 103
eISSN - 1939-1676
pISSN - 0891-6640
DOI - 10.1111/j.1939-1676.2012.00916.x
Subject(s) - medicine , confidence interval , heart failure , respiratory system , cats , natriuretic peptide , physical examination , gold standard (test) , cardiology
Background N ‐terminal pro‐ B ‐type natriuretic peptide ( NT ‐pro BNP ) can distinguish congestive heart failure ( CHF ) from primary respiratory disease in cats with respiratory signs with approximately 90% diagnostic accuracy, but the additive benefit of NT ‐pro BNP to improve the diagnosis obtained from conventional testing in individual cases remains unknown. Hypothesis NT ‐pro BNP will improve the diagnostic accuracy and confidence of general practice veterinarians in assessing cats with respiratory signs. Animals Ten cats with respiratory signs. Methods History, physical examination, thoracic radiographs, electrocardiogram ( ECG ), and biochemical analysis of 10 cats presented to the U niversity of P ennsylvania or T ufts U niversity with a history of respiratory signs were evaluated by 50 general practice veterinarians using an online survey tool. Participants were asked to provide (1) diagnosis of CHF or primary respiratory disease, and (2) level of confidence in their diagnosis (1, lowest to 10, highest) before and after disclosure of NT ‐pro BNP results. Diagnoses ( CHF , n = 5; primary respiratory, n = 5) were compared to the gold standard defined as consensus opinion of 3 board‐certified cardiologists blinded to the NT ‐pro BNP results. Results Overall correctness of the practitioners was 69.2%, and significantly increased after practitioners were provided NT ‐pro BNP results (87.0%, P = .0039). Median practitioner confidence before NT ‐pro BNP disclosure was 6 ( IQR , 5–8) and significantly increased after disclosure (8; IQR , 6–10; P = .0039). Conclusions These data indicate a relatively low accuracy and level of confidence in the diagnosis of feline respiratory signs. Use of NT ‐pro BNP assay in conjunction with conventional evaluation by general practitioners significantly improved their diagnostic accuracy and confidence.