EPA-1321 - Panic symptoms in patients with non-cardiac chest pain in the emergency department: a blind spot for emergency phycisians

Abstract

Introduction Non-cardiac chest pain (NCCP) is a common diagnosis among patients visiting an emergency department. 50–90% of patients presenting with chest pain are diagnosed with non-cardiac chest pain. One of the possible causes of NCCP is a psychiatric illness. Previous studies found high prevalence of panic disorder (25%-40%) using structured DSM-IV interviews. Objectives We wanted to review the occurrence of patients with a possible panic disorder in our emergency department. In case of high occurrence further interventions could be warranted. Aims To examine the frequency of panic disorder diagnosis by emergency physicians in patients with NCCP. Methods Electronic health records from all patients in the OLVG hospital presenting with cardiac pain at the emergency department with in January 2013 were reviewed in a retrospective cohort study. We substracted the final diagnosis by the emergency physician Results In this month 195 patients presented at the emergency department with chest pain. 121 (62%) suffered from non-cardiac chest pain. They were discharged with the following diagnosis: 13 (11%) pulmonal disease, 23 (19%) a musculoskeletal problem, 13 (11%) a gastro-intestinal diagnosis, 4 (3%) drug related, 63 (56%) were described as suffering from atypical chest pain. Only in 5 (4%) a psychologic cause was described as primary diagnosis. Conclusions We found a low rate of psychiatric diagnosis by emergency physicians in patients with NCCP compared to previous studies using structured interviews. Interventions are needed to improve the detection of psychiatric symptoms in our emergency department.