The Challenge of Triaging Chest Pain Patients : The Bernese University Hospital Experience

Abstract EN

Accurate diagnosis of the causes of chest pain and dyspnea remain challenging.

In this preliminary observational study with a 5-year follow-up, we attempted to find a simplified approach to selecting patients with chest pain needing immediate care based on the initial evaluation in ED.

During a 24-month period were randomly selected 301 patients and a conditional inference tree (CIT) was used as the basis of the prognostic rule.

Common diagnoses were musculoskeletal chest pain (27%), ACS (19%) and panic attack (12%).

Using variables of ACS symptoms we estimated the likelihood of ACS based on a CIT to be high at 91% (32), low at 4% (198) and intermediate at 20.5–40% in (71) patients.

Coronary catheterization was performed within 24 hours in 91% of the patients with ACS.

A culprit lesion was found in 79%.

Follow-up (median 4.2 years) information was available for 70% of the patients.

Of the 164 patients without ACS who were followed up, 5 were treated with revascularization for stable angina pectoris, 2 were treated with revascularization for myocardial infarction, and 25 died.

Although a simple triage decision tree could theoretically help to efficient select patients needing immediate care we need also to be vigilant for those presenting with atypical symptoms.Erratum to “The Challenge of Triaging Chest Pain Patients: The Bernese University Hospital Experience”dx.doi.org/10.1155/2012/493816