The Impact of Pregnancy on the Work-Up of Chest Pain and Shortness of Breath in the Emergency Department [14Q]. (May 2017)

• Record Type: Journal Article
• Authors: Wagner, Stephen; Waldman, Ian; Kunselman, Allen R.; Smith, Emily; Deimling, Timothy
• Is Part Of: Obstetrics and gynecology. Volume 129 (2017)Supplement 1
• Publication Date: 2017-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000514236.95278.19
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: This study investigates the comparative rates of imaging studies between pregnant and non-pregnant patients who presented for emergent evaluation of angina and dyspnea. METHODS: All reproductive age females presenting to the Emergency Department at an academic teaching institution with a chief complaint of "chest pain" or "shortness of breath" from 2010-2015 were identified. Cohorts were divided based on pregnancy status and chief complaint. The rate of utilization was calculated for each imaging study. Rates were compared between cohorts utilizing odds ratios and p-values. RESULTS: Over the study period, 4, 834 women were included. One hundred and seventy-four were pregnant. Pregnant patients with chest pain were significantly more likely to undergo a venous duplex (9.2% vs 1.5%), but less likely to undergo a chest x-ray (52.3% vs 85%) as compared to non-pregnant patients. The same disparity was present among pregnant patients presenting with shortness of breath: venous duplex 9.2% vs 2.7% and chest x-ray 26.15% vs 76.9% as compared to non-pregnant patients. There was no difference in the rates of chest CT imaging or MRI. CONCLUSION: Imaging studies are an integral adjunct for evaluation in patients reporting angina or dyspnea. Pregnancy places patients at an increased risk of severe sequelae requiring prompt diagnosis to prevent harm to the mother and fetus. The American College of Obstetricians and Gynecologists clearly states that, with few exceptions, radiography should not be withheld from pregnant patients. This study suggests that pregnant patients are significantly less likely to undergo radiography, which could place them at increased risk for delayed diagnosis and treatment.