Chest pain in the ambulance; prevalence, causes and outcome - a retrospective cohort study

Abstract

Background Chest pain is common in acute ambulance transports. This study aims to characterize and compare ambulance-transported chest pain patients to non-chest pain patients and evaluate if patient characteristics and accompanying symptoms accessible at the time of emergency call can predict cause and outcome in chest pain patients. Methods Retrospective, observational population-based study, including acute ambulance transports. Patient characteristics and symptoms are included in a multivariable risk model to identify characteristics, associated with being discharged without an acute cardiac diagnosis and surviving 30 days after chest pain event. Results In total, 10,033 of 61,088 (16.4%) acute ambulance transports were due to chest pain. In chest pain patients, 30-day mortality was 2.1% (95%CI 1.8–2.4) compared to 6.0% (95%CI 5.7–6.2) in non-chest pain patients. Of chest pain patients, 1054 (10.5%) were diagnosed with acute myocardial infarction, and 5068 (50.5%) were discharged without any diagnosis of disease. This no-diagnosis group had very low 30-day mortality, 0.4% (95%CI 0.2–0.9). Female gender, younger age, chronic pulmonary disease, absence of accompanying symptoms of dyspnoea, radiation, severe pain for > 5 min, clammy skin, uncomfortable, and nausea were associated with being discharged without an acute cardiac diagnosis and surviving 30 days after a chest pain event. Conclusion Chest pain is a common reason for ambulance transport, but the majority of patients are discharged without a diagnosis and with a high survival rate. Early risk prediction seems to hold a potential for resource downgrading and thus cost-saving in selected chest pain patients. Electronic supplementary material The online version of this article (10.1186/s13049-019-0659-6) contains supplementary material, which is available to authorized users.

Characteristics and outcomes of patients with dyspnoea as the main symptom, assessed by prehospital emergency nurses- a retrospective observational study

“…From an overall population perspective [20], it has been denoted that men have a greater vulnerability to cardiovascular diseases which is a reason to their higher mortality rate in general. Patients attending EMS due to dyspnoea appear to have a five times higher risk of death than those with chest pain [9,21]. This is in agreement with other reports saying that regardless of the aetiology, patients who have dyspnoea in combination with other conditions have a poor prognoses [22].…”

“…Patients attending EMS due to dyspnoea appear to have a five times higher risk of death than those with chest pain [ 9 , 21 ]. This is in agreement with other reports saying that regardless of the aetiology, patients who have dyspnoea in combination with other conditions have a poor prognoses [ 22 ].…”

“…The pain experience was mostly related to breathing-related chest discomfort, thoracic pain, chest wall pain, shoulder pain, or pain due to other unclear reasons. The presence of pain in dyspnoea patients has previously been reported [ 9 , 21 , 22 , 31 ], mostly in the form of chest pain as a result of underlying causes including pulmonary embolism myocardial infarction, pneumonia and panic disorder.…”

Introductory Chapter: The Patient Presenting with Chest Pain

“…It is the most frequent reason for presentation to an emergency facility in men age 65 years and older. In some cohorts, chest pain accounts for up to 16% of ambulance transports and constitutes almost 30% of emergency admissions [2,3]. In the primary care setting however, less than 1% of visits are for a chief complaint of chest pain [4].…”

Which symptoms pose the highest risk in patients calling for an ambulance? A population-based cohort study from Denmark

“…These initial symptoms or mechanism of injury at the rst patient contact seem to carry important prognostic information which might inform the care of the patient. However, outcomes have been investigated in isolated symptoms only, such as chest pain (13) and breathing di culty (14).…”