Chest Pain in the Emergency Department: Incidence, Clinical Characteristics, and Risk Stratification

Martínez‐Sellés, Manuel; Bueno, Héctor; Sacristán, Alberto; Estévez, Agustín; Ortíz, Javier; Gallego, Laura; Fernández‐Avilés, Francisco

doi:10.1016/s1885-5857(08)60256-x

Cited by 18 publications

(14 citation statements)

References 17 publications

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“…17 Scores developed in emergency departments include a broad range of different variables, including age, sex, risk factors and pain characteristics. 12,[21][22][23][24] One study determined the usefulness of pain reproduced by palpation of the chest wall for defining low-risk patients. 11 However, most of these studies used other reference diagnoses such as acute coronary syndromes, and all were performed in a setting where the prevalence of coronary artery disease is much higher than that in a primary care setting.…”

Section: Discussionmentioning

confidence: 99%

Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule

Bösner¹,

Haasenritter²,

Becker³

et al. 2010

Canadian Medical Association Journal

110

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Background: Chest pain can be caused by various conditions, with life-threatening cardiac disease being of greatest concern. Prediction scores to rule out coronary artery disease have been developed for use in emergency settings. We developed and validated a simple prediction rule for use in primary care. Methods:We conducted a cross-sectional diagnostic study in 74 primary care practices in Germany. Primary care physicians recruited all consecutive patients who presented with chest pain (n = 1249) and recorded symptoms and findings for each patient (derivation cohort). An independent expert panel reviewed follow-up data obtained at six weeks and six months on symptoms, investigations, hospital admissions and medications to determine the presence or absence of coronary artery disease. Adjusted odds ratios of relevant variables were used to develop a prediction rule. We calculated measures of diagnostic accuracy for different cut-off values for the prediction scores using data derived from another prospective primary care study (validation cohort). Results:The prediction rule contained five determinants (age/sex, known vascular disease, patient assumes pain is of cardiac origin, pain is worse during exercise, and pain is not reproducible by palpation), with the score ranging from 0 to 5 points. The area under the curve (receiver operating characteristic curve) was 0.87 (95% confidence interval [CI] 0.83-0.91) for the derivation cohort and 0.90 (95% CI 0.87-0.93) for the validation cohort. The best overall discrimination was with a cut-off value of 3 (positive result 3-5 points; negative result ≤ 2 points), which had a sensitivity of 87.1% (95% CI 79.9%-94.2%) and a specificity of 80.8% (77.6%-83.9%). Interpretation:The prediction rule for coronary artery disease in primary care proved to be robust in the validation cohort. It can help to rule out coronary artery disease in patients presenting with chest pain in primary care. AbstractPreviously published at www.cmaj.ca @@

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Section: Discussionmentioning

confidence: 99%

Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule

Bösner¹,

Haasenritter²,

Becker³

et al. 2010

Canadian Medical Association Journal

110

View full text Add to dashboard Cite

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“…[12][13][14][15][16][17] The incidence of chest pain-related visits to the ED is 8-19 per 1000 person-years, 12,16,17 being higher in urban than in rural hospitals, with a mean age of 52-61 years, and with 49-57% of men. 12,13,[15][16][17] In current practice, about half of the patients presenting with chest pain can be discharged without further hospitalisation from the ED. 15,16 The great majority of these patients (83%) are discharged with a non-cardiac cause of the chest pain (unspecified chest pain in 48% and other non-cardiac causes in 35%).…”

Section: Epidemiologymentioning

confidence: 99%

Diagnosis and risk stratification of chest pain patients in the emergency department: focus on acute coronary syndromes. A position paper of the Acute Cardiovascular Care Association

Stępińska

Lettino

Ahrens

et al. 2020

European Heart Journal: Acute Cardiovascular Care

104

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“…The literature suggests that up to 15% of hospital admissions for chest pain are attributable to pulmonary disease. [4][5][6] The most important factor in making an accurate diagnosis of pleuritic chest pain is to establish whether the pain is truly pleuritic in nature and not, for example, the 'typical' dull, crushing sensation of cardiac ischaemia or the tearing pain that radiates to the back of aortic dissection. Other symptoms suggestive of infection or trauma are then useful discriminators.…”

Section: What Are the Causes Of Pleuritic Pain And The Clinical Featu...mentioning

confidence: 99%

Problem based review: Pleuritic Chest Pain

Lee

Le²,

Mb³

et al. 2012

Acute Med

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Pleuritic pain, a sharp discomfort near the chest wall exacerbated by inspiration is associated with a number of pathologies. Pulmonary embolus and infection are two common causes but diagnosis can often be challenging, both for experienced physicians and trainees. The underlying anatomy and pathophysiology of such pain and the most common aetiologies are presented. Clinical symptoms and signs that may arise alongside pleuritic pain are then discussed, followed by an introduction to the diagnostic tools such as the Wells’ score and current guidelines that can help to select the most appropriate investigation(s). Management of pulmonary embolism and other common causes of pleuritic pain are also discussed and highlighted by a clinical vignette.

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Chest Pain in the Emergency Department: Incidence, Clinical Characteristics, and Risk Stratification

Cited by 18 publications

References 17 publications

Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule

Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule

Diagnosis and risk stratification of chest pain patients in the emergency department: focus on acute coronary syndromes. A position paper of the Acute Cardiovascular Care Association

Problem based review: Pleuritic Chest Pain

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