Abstract
BackgroundChest 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.MethodsRetrospective, 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.ResultsIn 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.ConclusionChest 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.
Highlights
Chest pain is one of the most frequent symptoms among patients contacting the emergency medical services (EMS) and emergency departments (EDs) [1, 2]
Characteristics of study subjects We identified 71,891 acute ambulance transports in the prehospital dispatch system during the study period, see flowchart in Additional file 1
After exclusion of patients requesting an ambulance due to conditions with very high risk of mortality, the 30-day mortality in nonchest pain patients were still more than twice as high as in chest pain patients (4.7% (95%confidence interval (CI) 4.5–5.0) vs 2.1% (95%CI 1.8–2.4))
Summary
Chest pain is one of the most frequent symptoms among patients contacting the emergency medical services (EMS) and emergency departments (EDs) [1, 2]. Since chest pain is associated with potential life threatening conditions like acute myocardial infarction (AMI), pulmonary embolism or acute aortic dissection, the EMS response is most often dispatched in an “all or nothing”fashion with a high triage level and immediate response. This level of triage is relevant in patients with a subsequent confirmed serious/adverse diagnosis and may favour an improved outcome [6, 7]. 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
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