How do patients with chest pain access Emergency Department care?

Abstract

Supplemental Digital Content is available in the text.

Pre-hospital delay in patients with acute chest pain

“…The average time between the onset of chest pain and the decision to call for an ambulance in this study was 11.97 h, with a median of two hours, which is longer than the study by Kathleen et al 16 where this time was 9.14 h, median 1.90 h. The largest number of patients with chest pain in this study (n = 152 or 43.55 %) were in the group in which the time interval between the onset of chest pain and placing a call to the EMS was ≤ 1 h. These data differ significantly from the study conducted in Belgium by Van Severen et al, 10 where only 9 % of patients were in the group where the time between the onset of chest pain and hospitalisation was < 1 h. According to their results, the largest number of patients, ie 32 %, arrived at the hospital after 3-12 h since the onset of the complaint, whereas in this study, 33.5 % or 117 patients, decided in the time interval of 2-24 h from the onset of pain to call the EMS. 10 The largest number of patients with chest pain in the present study was in the group who waited up to one hour to make a call the EMS and the lowest percentage of patients (9.45 %) decided to call the EMS in the time interval of 24-48 h after the onset of symptoms. There were 9.45 % of patients in the group that waited ≥ 24 h. In this group, there was also one patient who stated that his pain had been lasting all the time.…”

“…9 Early referral of possible acute myocardial infarction (AMI) to hospitals is crucial for survival and subsequent quality of life. 10 Various studies have been conducted on prehospital delay in patients with chest pain. 9,11 Observational studies indicate that a number of factors may be associated with patients' delay in seeking medical attention for non-traumatic chest pain.…”

Enhanced triage for patients with suspected cardiac chest pain: the History and Electrocardiogram-only Manchester Acute Coronary Syndromes decision aid

“…Finally, the algorithm could be used in settings where blood testing is not available, such as in primary care. This is often the first medical contact for patients with chest pain and a high percentage of those patients are referred to the ED [12]. Thus, HE-MACS could help to avoid unnecessary ED referrals and immediately rule out ACS in those settings.…”

De huisarts is een prima sneltest bij pijn op de borst

“…Mensen met POB en ernstige, vegetatieve klachten bellen vaak direct 112, al dan niet doorgeschakeld na telefonisch overleg met de huisarts(enpost). 2 Toch beoordeelt de huisarts een groot aantal patiënten (jaarlijks in Nederland zo'n 860.000) met veelal mildere klachten zelf. 2,3 Daarmee is POB de reden van komst in 1,26% van alle huisartsconsulten.…”

“…2 Toch beoordeelt de huisarts een groot aantal patiënten (jaarlijks in Nederland zo'n 860.000) met veelal mildere klachten zelf. 2,3 Daarmee is POB de reden van komst in 1,26% van alle huisartsconsulten. De uiteindelijke diagnose bij POB in de huisartsenpraktijk is meestal niet levensbedreigend: in 35% van de gevallen gaat het om een ICPC-code gerelateerd aan het bewegingsapparaat, 18% krijgt een psychosociale diagnose, inclusief 'primaire hyperventilatie' , in 14% van de gevallen is de einddiagnose gastro-intestinaal van aard en bij 8% is sprake van een (infectieus) respiratoir beeld.…”