RESUMEN
We performed a prospective study to describe the broad spectrum of causes of chest pain in patients presenting to the emergency department and to compare the diagnoses in referred patients, self-referred patients and patients rushed in by ambulance. The final diagnosis in a consecutive case series of 578 chest pain patients was established after discharge from the hospital. The underlying disorders were grouped into cardiac, respiratory, gastro-oesophageal disorders, musculoskeletal pathology, somatization disorders, other diseases and unknown. For comparison of the frequencies of the disease categories the Chi-squared test was used. Out of 578 patients, 161 (27.9%) were self-referred, 369 (63.8%) were referred by the general practitioner and 48 (8.3%) were rushed in by ambulance. Cardiac diseases represented 51.7% of the cases, myocardial infarction and unstable angina 19% and 12.8% respectively Cardiac diseases were statistically significantly less common in self-referred patients (p<0.0005). Pulmonary diseases encompassed 14.2% of the population, followed by somatization disorders (9.2%), musculoskeletal pathology (7.1%) and other causes (4.3%). In 11.1% of the cases no definite final diagnosis could be established. Somatization disorders were significantly more frequent in self-referred and ambulance patients. Cardiac and pulmonary problems are the most frequent underlying disorders in acute chest pain patients in the emergency department. Somatization disorders and musculoskeletal pathology represented respectively 19.1% and 14.8% of the non-cardiac causes. The referral pattern influenced significantly the distribution of the disease categories with more cardiac and less psychiatric disorders in referred patients.
Asunto(s)
Dolor en el Pecho/etiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Cardiopatías/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Bélgica , Humanos , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/complicaciones , Enfermedades Musculoesqueléticas/diagnóstico , Estudios Prospectivos , Trastornos Somatomorfos/complicaciones , Trastornos Somatomorfos/diagnósticoRESUMEN
OBJECTIVE: The aim of the present study was to provide a description of the impact of setting on the diagnostic case mix that is identified in consecutive patients presenting with chest pain. METHODS: A cross-sectional study was carried out of patients presenting with chest pain according to setting: general practice, self-referred, referred or arriving by ambulance at the hospital emergency department (ED). GPs from 25 general practices situated in the Flemish part of Belgium were recruited, and the hospital involved was a major teaching hospital in the same area. A total of 320 patients in general practice and 580 patients in the hospital ED were studied. The difference in prevalence rates for the major diagnostic categories was the main outcome measure. RESULTS: Gastrointestinal disorders, musculoskeletal problems and psychopathology are identified more frequently in general practice; and serious lung diseases and cardiovascular diseases in the hospital ED. Within the hospital, there is a strong trend towards increasing frequency of serious cardiovascular diseases including unstable angina (P = 0.01) from self-referred to referred patients and those rushed in by ambulance. The opposite trend was identified for respiratory (P = 0.02) and musculoskeletal (P = 0.07) diseases. The diagnostic case mix in self-referred patients tends to be more similar to the other groups of hospital patients than to patients in general practice. CONCLUSIONS: There is a large difference between the diagnostic case mix presented in general practice compared with the ED and among referral-related subgroups within the hospital emergency department.