BJGP Open最新文献

{"title":"Primary care contact, clinical management, and suicide risk following discharge from inpatient mental health care: a case-control study.","authors":"Rebecca Musgrove, Matthew J Carr, Nav Kapur, Carolyn A Chew-Graham, Faraz Mughal, Darren M Ashcroft, Roger T Webb","doi":"10.3399/BJGPO.2023.0165","DOIUrl":"10.3399/BJGPO.2023.0165","url":null,"abstract":"<p><strong>Background: </strong>Evidence is sparse regarding service usage and the clinical management of people recently discharged from inpatient psychiatric care who die by suicide.</p><p><strong>Aim: </strong>To improve understanding of how people discharged from inpatient mental health care are supported by primary care during this high-risk transition.</p><p><strong>Design & setting: </strong>A nested case-control study, utilising interlinked primary and secondary care records in England for people who died within a year of discharge between 2001 and 2019, matched on age, sex, practice-level deprivation, and region with up to 20 living discharged people.</p><p><strong>Method: </strong>We described patterns of consultation, prescription of psychotropic medication, and continuity of care for people who died by suicide and those who survived. Mutually adjusted relative risk estimates were generated for a range of primary care and clinical variables.</p><p><strong>Results: </strong>More than 40% of patients who died within 2 weeks of discharge and >80% of patients who died within 1 year of discharge had at least one primary care consultation within the respective time periods. Evidence of discharge communication from hospital was infrequent. Within-practice continuity of care was relatively high. Those who died by suicide were less likely to consult within 2 weeks of discharge (adjusted odds ratio [AOR] 0.61 [95% confidence interval {CI} = 0.42 to 0.89]), more likely to consult in the week before death (AOR 1.71 [95% CI = 1.36 to 2.15]), be prescribed multiple types of psychotropic medication (AOR 1.73 [95% CI = 1.28 to 2.33]), experience readmission, and have a diagnosis outside of the 'severe mental illness' definition.</p><p><strong>Conclusion: </strong>Primary care clinicians have opportunities to intervene and should prioritise patients experiencing transition from inpatient care. Clear communication and liaison between services is essential to provide timely support.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GPs' reflections on prescribing addictive hypnotics to older people: a qualitative study.","authors":"Holgeir Skjeie, Mette Brekke, Trygve Skonnord","doi":"10.3399/BJGPO.2024.0157","DOIUrl":"10.3399/BJGPO.2024.0157","url":null,"abstract":"<p><strong>Background: </strong>The European guideline for the diagnosis and treatment of insomnia recommends, for all age groups, only restrictive, short-term, and periodic use of potentially addictive hypnotics. As in other European countries, in Norway, actual practice involving older patients differs substantially from this recommendation, as shown by the persistent high frequency of regular prescriptions of addictive hypnotics.</p><p><strong>Aim: </strong>To explore experienced Norwegian GPs' views of the regular prescription of addictive hypnotics to patients aged >70 years living at home.</p><p><strong>Design & setting: </strong>In-depth individual interviews of a purposive sample of experienced specialists in family medicine at GP offices in Southern Norway.</p><p><strong>Method: </strong>The interviews used a semi-structured interview guide and were performed between June 2022 and January 2023. Reflexive thematic cross-case analysis was used to analyse the data.</p><p><strong>Results: </strong>Most of the 11 GPs interviewed had more than 10 older patients who were prescribed hypnotics for daily use and the same number for intermittent prescription. Almost all prescriptions were of z-hypnotics. The GPs knew this was contrary to the guideline. Many were at ease with this fact. They emphasised the need to avoid creating new dependencies. The GPs considered these patients a selected minority within this age group with serious sleep problems, for whom few realistic alternatives were available and whose tolerance over time was better than expected. This logic of pragmatic practice reflected a patient-centred approach and respect for the patient's view in a shared decision-making process, combined with challenges of limited alternatives and resources.</p><p><strong>Conclusion: </strong>A 'zero vision' on the prescription of addictive hypnotics to older people may neither be prudent nor realistic in the context of general practice.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'ThinkCancer!': randomised feasibility trial of a novel practice-based early cancer diagnosis intervention.","authors":"Stefanie Lj Disbeschl, Annie K Hendry, Alun Surgey, Daniel Walker, Nia Goulden, Bethany F Anthony, Richard Neal, Nefyn H Williams, Zoë Susannah Jane Hoare, Julia Hiscock, Rhiannon Tudor Rt Edwards, Ruth Lewis, Clare Wilkinson","doi":"10.3399/BJGPO.2023.0220","DOIUrl":"10.3399/BJGPO.2023.0220","url":null,"abstract":"<p><strong>Background: </strong>UK cancer deaths remain high; primary care is key for earlier cancer diagnosis as half of avoidable delays occur here. Improvement is possible through lower referral thresholds, better guideline adherence, and better safety-netting systems. Few interventions target whole practice teams. We developed a novel whole-practice team intervention to address this.</p><p><strong>Aim: </strong>To test the feasibility and acceptability of a novel, complex behavioural intervention, 'ThinkCancer!', for assessment in a subsequent Phase III trial.</p><p><strong>Design & setting: </strong>Pragmatic, superiority pilot randomised controlled trial (RCT) with an embedded process evaluation and feasibility economic analysis in Welsh general practices.</p><p><strong>Method: </strong>Clinical outcome data were collected from practices (the unit of randomisation). Practice characteristics and cancer safety-netting systems were assessed. Individual practice staff completed evaluation and feedback forms and qualitative interviews. The intervention was adapted and refined.</p><p><strong>Results: </strong>Trial recruitment and workshop deliveries took place between March 2020 and May 2021. Trial progression criteria for recruitment, intervention fidelity, and routine data collection were met. Staff-level fidelity, retention, and individual level data collection processes were reviewed and amended. Interviews highlighted positive participant views on all aspects of the intervention. All practices set out to liberalise referral thresholds appropriately, implement guidelines, and address safety-netting plans in detail.</p><p><strong>Conclusion: </strong>'ThinkCancer!' appears feasible and acceptable. The new iteration of the workshops was completed and the Phase III trial has been funded to assess the effectiveness and cost-effectiveness of this novel professional behaviour change intervention. Delivery at scale to multiple practices will likely improve fidelity and reach.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing patients with eating disorders: a qualitative study in primary care.","authors":"Carrie Ashby, Jane Ogden","doi":"10.3399/BJGPO.2024.0014","DOIUrl":"10.3399/BJGPO.2024.0014","url":null,"abstract":"<p><strong>Background: </strong>GPs play a key role in the diagnosis and management of eating disorders (EDs).</p><p><strong>Aim: </strong>To explore GPs' experiences of managing patients with EDs.</p><p><strong>Design & setting: </strong>A qualitative study utilising remote semi-structured interviews in the UK.</p><p><strong>Method: </strong>Fourteen GPs were interviewed about their experiences of supporting patients with EDs. The interviews were recorded, transcribed, and analysed using thematic analysis.</p><p><strong>Results: </strong>The analysis described the following four themes: (i) 'Continuity of care', addressing the GP's relationship with patients and family, patient transitions across life stages and geographical areas, and patient non-attendance; (ii) 'The role of guidance', focusing on guidelines and protocols, referrals and specialist professionals as points of contact; (iii) 'Structural barriers', including waiting times, lack of resources, referral criteria, and relationships between services; (iv) 'Confidence and skills', reflecting professional and personal experience in EDs, previous training and training needs. Transcending these themes was the notion of the 'Limits to the care' GPs can provide owing to professional boundaries and the emotional impact of managing patients with EDs.</p><p><strong>Conclusion: </strong>This study found that while GPs want to help patients with EDs many limits remain to the care they can provide owing to both internal and external factors. Funding is required for training and accessible specialist ED support, and greater clarity is needed regarding referral processes if ED management in primary care is to be optimised.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family medicine journals' endorsement of reporting guidelines and clinical trial registration: a cross-sectional analysis.","authors":"Wyatt Compton, Brody Dennis, Payton Clark, Caleb A Smith, Danya Nees, Griffin Hughes, Matt Vassar","doi":"10.3399/BJGPO.2023.0183","DOIUrl":"10.3399/BJGPO.2023.0183","url":null,"abstract":"<p><strong>Background: </strong>Family medicine, vital for patient care but underfunded, prompts an evaluation of how family medicine journals endorse, require, and advocate for reporting guidelines (RGs), clinical trial, and systematic review registration.</p><p><strong>Aim: </strong>Assess endorsement and requirement of RGs, and the stance on registration of clinical trials and systematic reviews in family medicine journals, impacting research quality and transparency.</p><p><strong>Design & setting: </strong>A cross-sectional analysis of 43 'family practice' journals, identified through the 2021 Scopus CiteScore, was undertaken. Editors-in-chief were contacted to confirm article types. Data extracted from 'instructions to authors' pages focused on recommendations or requirements for use of RGs, and for trial registration.</p><p><strong>Method: </strong>To ensure confidentiality and prevent bias, authors independently extracted data on the requirement or recommendation for use of RGs and clinical trial registration to provide an overview of research standards.</p><p><strong>Results: </strong>From the 43 journals, the most recommended guidelines were CONSORT (69%), PRISMA (58%), and STROBE (60%). The most required were PRISMA (16%) and CONSORT (11%). Clinical trial registration was recommended or required by 67% of journals. Additionally, 40 out of the 43 (93%) journals cited at least one reporting guideline in their instructions to authors.</p><p><strong>Conclusion: </strong>Family medicine journals exhibit a variety of endorsement and requirement patterns for RGs and clinical trial registration. While guidelines like CONSORT, PRISMA, and STROBE are acknowledged, caution is needed in presuming a direct link between mention of these RGs and enhanced research quality. A nuanced approach, promoting diverse RGs and rigorous study registration, is essential for elevating transparency and advancing research standards in family medicine.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and management of Lyme disease: a Scottish general practice retrospective study.","authors":"Sally Mavin, Swapna Guntupalli, Michael Robb","doi":"10.3399/BJGPO.2023.0241","DOIUrl":"10.3399/BJGPO.2023.0241","url":null,"abstract":"<p><strong>Background: </strong>The true burden of Lyme disease in primary care in Scotland is unknown. Epidemiological data are currently based on laboratory-confirmed reports as there is no mandatory reporting of clinical cases.</p><p><strong>Aim: </strong>To analyse data from general practice in NHS Highland (North) over a 6-year period to assess the incidence and management of Lyme disease in primary care.</p><p><strong>Design & setting: </strong>This was a retrospective descriptive study. Study data from 2017 to 2022 were extracted from all 63 general practices within NHS Highland (North).</p><p><strong>Method: </strong>Consultations for Lyme disease were identified via Lyme-related clinical Read codes, requests for borrelia tests , free text, 'tags' and/or Lyme disease antibiotic scripts.</p><p><strong>Results: </strong>Using Read codes to identify patients with Lyme disease or suspected Lyme disease gave an estimated average annual incidence of 124/100 000 population, which was 2.1 times more than estimates based solely on laboratory-confirmed reports. The incidence figures increased 5.2 times (362/100 000 population) when patients with Lyme disease or suspected Lyme disease (identified via Read codes, laboratory test requests, and free text tags) who were given antibiotic treatment were taken into account. Local 'hot spots' of infection were identified. Analysis of the antibiotic data indicates that antibiotic prescribing in NHS Highland largely follows the National Institute for Health and Care Excellence (NICE) guidelines.</p><p><strong>Conclusion: </strong>This data analysis pathway can, and should, be rolled out across the whole of Scotland to assess the incidence and management of Lyme disease in primary care and allow appropriate allocation of resources.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying where hospital and community trusts are managing general practices in England: a service mapping study.","authors":"Charlotte Davies, Catherine L Saunders, Fifi Olumogba, Manbinder Sidhu, Jon Sussex","doi":"10.3399/BJGPO.2023.0173","DOIUrl":"10.3399/BJGPO.2023.0173","url":null,"abstract":"<p><strong>Background: </strong>Organisations providing secondary care in the NHS in England have historically not also provided primary health care, but this is changing. Data on where this kind of 'vertical integration' is happening are lacking, making it difficult to evaluate its impact.</p><p><strong>Aim: </strong>To compile a comprehensive list of instances of secondary care trusts running general practices in England, to enable evaluation of the impact of such arrangements.</p><p><strong>Design & setting: </strong>This service mapping study comprises review, collation, synthesis, and analysis of published information describing secondary and primary care provision in the NHS in England in March 2021.</p><p><strong>Method: </strong>Desk-based collection, including hand-searching, of secondary care organisations' statutory annual reports. Triangulation via comparison with national data on general practices, the general practice workforce and practice contracts.</p><p><strong>Results: </strong>It was possible to construct a database of all instances of trusts running general practices in England as of 31 March 2021. We have identified 26 trusts running a total of 85 general practices, operating across a total of 116 practice sites. These practices have on average fewer patients and fewer GP full-time equivalents than other general practices, and before becoming vertically integrated were performing less well in the Quality and Outcomes Framework.</p><p><strong>Conclusion: </strong>We recommend that national statistics recording the details of general practices contracting with the NHS should include whether each practice is owned by another organisation and whether that is an NHS trust, another public body, or a private organisation. Such data are required to enable evaluation of the impacts of this kind of vertical integration.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139479409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NHS national data opt-outs: trends and potential consequences for health data research.","authors":"John Tazare, Alasdair D Henderson, Jessica Morley, Helen A Blake, Helen I McDonald, Elizabeth J Williamson, Helen Strongman","doi":"10.3399/BJGPO.2024.0020","DOIUrl":"10.3399/BJGPO.2024.0020","url":null,"abstract":"<p><strong>Background: </strong>The English NHS data opt-out allows people to prevent use of their health data for purposes other than direct care. In 2021, the number of opt-outs increased in response to government-led proposals to create a centralised pseudonymised primary care record database.</p><p><strong>Aim: </strong>To describe the potential impact of NHS national data opt-outs in 2021 on health data research.</p><p><strong>Design & setting: </strong>We conducted a descriptive analysis of opt-outs using publicly available data and the potential consequences on research are discussed.</p><p><strong>Method: </strong>Trends in opt-outs in England were described by age, sex, and region. Using a hypothetical study, we explored statistical and epidemiological implications of opt-outs.</p><p><strong>Results: </strong>During the lead up to a key government-led deadline for registering opt-outs (from 31 May 2021-30 June 2021), 1 339 862 national data opt-outs were recorded; increasing the percentage of opt-outs in England from 2.77% to 4.97% of the population. Among females, percentage opt-outs increased by 83% (from 3.02% to 5.53%) compared with 76% in males (from 2.51% to 4.41%). Across age groups, the highest relative increase was among people aged 40-49 years, which rose from 2.89% to 6.04%. Considerable geographical variation was not clearly related to deprivation. Key research consequences of opt-outs include reductions in sample size and unpredictable distortion of observed measures of the frequency of health events or associations between these events.</p><p><strong>Conclusion: </strong>Opt-out rates varied by age, sex, and place. The impact of this and variation by other characteristics on research is not quantifiable. Potential effects of opt-outs on research and consequences for health policies based on this research must be considered when creating future opt-out solutions.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary mental health care for adults with mild intellectual disabilities: a focus group study of care professionals' perspectives.","authors":"Katrien Pm Pouls, Mathilde Mastebroek, Suzanne A Ligthart, Willem Jj Assendelft, Monique Cj Koks-Leensen, Geraline L Leusink","doi":"10.3399/BJGPO.2023.0247","DOIUrl":"10.3399/BJGPO.2023.0247","url":null,"abstract":"<p><strong>Background: </strong>GPs and mental health nurse practitioners (MHNPs) often feel ill equipped to provide mental health (MH) care to people with mild intellectual disabilities (MID). This is worrying, as insufficient primary MH care may lead to more severe or chronic problems. To improve primary MH care for this patient group, account must be taken of the experiences and needs of GPs and MHNPs providing the care.</p><p><strong>Aim: </strong>To explore GPs' and MHNPs' experiences, needs, and recommendations for improvement regarding primary MH care for adults with MID.</p><p><strong>Design & setting: </strong>A qualitative study was undertaken using focus groups with GPs and MHNPs in the Netherlands.</p><p><strong>Method: </strong>The focus groups were guided by topics based on an interview study with adults with MID receiving primary MH care. Transcripts were analysed by thematic analysis.</p><p><strong>Results: </strong>Four focus groups, with 19 GPs and nine MHNPs, revealed four themes describing the needs and perceived complexity involved in providing MH care to patients with both MID and MH problems: (1) GPs' and MHNPs' struggles with adapting to challenging patient characteristics; (2) importance and difficulties of establishing a good doctor-patient relationship; (3) facilitating and hampering roles of the patient's network; and (4) GPs' and MHNPs' challenges to provide care in the healthcare chain.</p><p><strong>Conclusion: </strong>GPs and MHNPs often experience providing care and support to this patient group as burdensome. It is important to consider the MID throughout the MH trajectory, to invest in a strong doctor-patient relationship, and to establish a stable, sustainable network and coordinated collaborative care around the patient.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Signs and symptoms of serious illness in adults with acute abdominal pain presenting to ambulatory care: a systematic review.","authors":"Anouk Tans, Thomas Struyf, Rune Geboers, Toon Smeets, Yorick Asselbergh, Emmanuel Declerck, Luca Bloemen, Ann van den Bruel","doi":"10.3399/BJGPO.2023.0245","DOIUrl":"10.3399/BJGPO.2023.0245","url":null,"abstract":"<p><strong>Background: </strong>Acute abdominal pain is a common complaint, caused by a variety of conditions, ranging from acutely life-threatening to benign and self-limiting, with symptom overlap complicating diagnosis. Signs and symptoms may be valuable when assessing a patient to guide clinical work.</p><p><strong>Aim: </strong>Summarising evidence on the accuracy of signs and symptoms for diagnosing serious illness in adults with acute abdominal pain in an ambulatory care setting.</p><p><strong>Design & setting: </strong>We performed a systematic review, searching for prospective diagnostic accuracy studies that included adults presenting with acute abdominal pain to an ambulatory care setting.</p><p><strong>Method: </strong>Six databases and guideline registers were searched, using a comprehensive search strategy. We assessed the risk of bias, and calculated descriptive statistics and measures of diagnostic accuracy. Results were pooled when at least four studies were available.</p><p><strong>Results: </strong>Out of 18 923 unique studies, 16 studies with moderate to high-risk bias were included. Fourteen clinical features met our criteria, including systolic blood pressure <100 mmHg (positive likelihood ratio [LR+]7.01), shock index >0.85, uterine cervical motion tenderness (LR+5.62 and negative likelihood ratio [LR-]8.60), and a self-assessment questionnaire score >70 (LR+12.20) or <25 (LR-0.19). Clinical diagnosis made by the clinician had the best rule-in ability (LR+24.6).</p><p><strong>Conclusions: </strong>We identified 14 signs and symptoms that can influence the likelihood of a serious illness, including pain characteristics, systemic signs, gynaecological signs, and clinician's overall assessment. The risk of bias was moderate to high, leading to uncertainty and preventing us from making firm conclusions. This highlights the need for better research in this setting.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}