title: Factors that impact upon the time to hospital presentation following the onset of chest pain.
abstract: BACKGROUND
  Although morbidity and mortality associated with chest pain are related to time to intervention, many patients have delayed ED presentations. We aimed to assess the extent of and reasons for prehospital delay, and identify patient subgroups more at risk of delayed presentation.
  
  
  METHODS
  This was an analytical, cross-sectional survey of patients with undifferentiated, potentially ischaemic chest pain, at a tertiary referral ED. Data were collected on the circumstances surrounding the chest pain incident (including components of total prehospital time) and the proportion of delayed presentations (defined as >3 h). Multiple linear regression determined variables significantly associated with prehospital time.
  
  
  RESULTS
  One hundred and fifty patients were enrolled. Mean age was 51.9+/-15.9 years and 90 (60.0%, 95% CI 51.7-67.8) were male. The mean total prehospital time was 6.38 h (median 3.17). Seventy-nine (52.7%, 95% CI 44.4-60.8) patients had a delayed presentation (>3 h) and those most at risk of this were those at home at pain onset and those with a history of AMI. The decision time (from onset of pain to decision to present) comprised the majority (82.8%) of total prehospital time. Factors positively associated with decision time were: waiting to see if symptoms resolved (P<0.0001), seeking GP advice (P<0.0001), fluctuating symptoms (P=0.02), embarrassment (P=0.01) and attributing symptoms to muscle problems (P=0.04). Nine patients diagnosed with AMI had a mean total prehospital time of 10.2 h.
  
  
  CONCLUSIONS
  Intensified efforts are required to promote awareness of the need to present directly to the ED upon the onset of chest pain. The factors associated with decision delay may help to inform revisions in public education initiatives.
authors.affiliation: Emergency Department, Royal Melbourne Hospital, and Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia. david.taylor@mh.org.au
authors.forename: David McD
authors.initials: DM
authors.lastname: Taylor
authors.forename: Devinder
authors.initials: D
authors.lastname: Garewal
authors.forename: Michael
authors.initials: M
authors.lastname: Carter
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
authors.forename: Anuradha
authors.initials: A
authors.lastname: Aggarwal
mesh_terms: D002637:Chest Pain; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006266:Health Education; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D013997:Time Factors; D014739:Victoria