title: Correlates of major complications and mortality in patients presenting to the emergency department with chest pain and more than bibasilar rales.
abstract: OBJECTIVE
  To identify correlates of major complications and mortality in patients presenting to the emergency department with chest pain and more than bibasilar rales.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  The emergency departments of three university and four community hospitals.
  
  
  METHODS
  Five hundred patients more than 30 years of age presenting to the emergency departments between 1984 and 1985 with a chief complaint of chest pain not explained by obvious trauma or chest x-ray abnormalities, and more than bibasilar rales on physical examination.
  
  
  RESULTS
  A standard data form was used to collect the history, physical examination, vital sign, and electrocardiographic findings. Chart review was carried out to record complications and mortality. One hundred eleven (22%) of the patients had a major complication (ventricular fibrillation, Mobitz II heart block, complete heart block, atrioventricular dissociation, cardiogenic shock, cardiac arrest, endotracheal intubation, intra-aortic balloon pump) or died, 160 (32%) were diagnosed as having myocardial infarction, and 58 (12%) died. Of those patients who had major complications or who died, the first complication occurred within six hours of hospital admission for 32% of the patients and within 24 hours for 47% of the patients. Univariate correlates (p < 0.10) of a major complication or death were entered into a stepwise logistic regression model. In the multivariate model, ST elevation or Q waves not known to be old [adjusted odds ratio (OR) 5.8, 95% confidence interval (CI) 3.0-11.1], ST-T changes of ischemia not known to be old (OR 2.6, 95% CI 1.5-4.6), systolic blood pressure < or = 120 mm Hg (OR 3.2, 95% CI 1.9-5.6), and age > 70 years (OR 1.8, 95% CI 1.1-3.0) were correlates of a major complication or death.
  
  
  CONCLUSIONS
  For patients presenting to the emergency department with chest pain and more than bibasilar rales, major electrocardiographic changes, systolic blood pressure < or = 120 mm Hg, and age > 70 years were correlated with a higher risk of a major complication or death.
authors.affiliation: Section for Clinical Epidemiology, Brigham and Women's Hospital, Boston, MA 02115.
authors.forename: M H
authors.initials: MH
authors.lastname: Chin
authors.forename: E F
authors.initials: EF
authors.lastname: Cook
authors.forename: T H
authors.initials: TH
authors.lastname: Lee
authors.forename: L
authors.initials: L
authors.lastname: Goldman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000401:mortality*; D002637:Chest Pain / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012135:Respiratory Sounds; D012307:Risk Factors; D013997:Time Factors