Usefulness of pain presentation characteristics for predicting outcome in patients presenting to the hospital with chest pain of uncertain origin. Issue 10 (15th September 2010)

• Record Type: Journal Article
• Authors: Sanchis, Juan; Bodí, Vicent; Núñez, Julio; Bosch, Xavier; Heras, Magda; Bonanad, Clara; Pellicer, Mauricio; Merlos, Pilar; Miñana, Gema; Llácer, Angel
• Is Part Of: Emergency medicine journal. Volume 28:Issue 10(2011)
• Page Start: 847
• Page End: 850
• Publication Date: 2010-09-15
• Subjects: Cardiac care -- diagnosis -- acute coronary syndrome -- chest—non trauma; Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1136/emj.2010.098160
• Languages: English
• ISSNs: 1472-0205

Abstract

Abstract : Background: Decision making in chest pain of uncertain origin is challenging. Objectives: To evaluate the predictive value of simple characteristics of pain presentation in patients coming to the emergency department with chest pain and without electrocardiogram ischaemia or raised troponin. Methods: 789 patients were studied. The following categorical pain characteristics were collected: effort related pain, pressing character, radiation, associated symptoms, and ≥2 episodes in 24 h. Additionally, a predefined semi-quantitative pain score including seven items (Geleijnse score) was completed. Risk factors and co-morbidities were also recorded. The primary and secondary endpoints were cardiac events at 30 days and at 1 year. Results: After adjusting for risk factors and co-morbidites, the pain characteristics associated with the primary and secondary endpoints were effort related pain (HR=2.1, 95% CI 1.5 to 3.0, p=0.0001; HR=1.8, 95% CI 1.3 to 2.5, p=0.0003) and ≥2 episodes in 24 h (HR=2.4, 95% CI 1.7 to 3.5, p=0.0001; HR=2.3, 95% CI 1.7 to 3.2, p=0.0001). Both variables retained their predictive value in women, diabetics and elderly (>70 years) patients. The discriminatory capacity of the predictive models including these two pain characteristics for the primary and secondary endpoints (C-statistic 0.76 and 0.76) was better than using the complex semi-quantitative pain score (C-statistic 0.69 and 0.71). Conclusion: In patients presenting to the emergency department with chest pain and without electrocardiogram ischaemia or raised troponin, effort related pain and ≥2 episodes in 24 h are the main characteristics to be considered for decision making.