title: Chest pain in the emergency department: incidence, clinical characteristics and risk stratification.
abstract: OBJECTIVE
  Although chest pain is a common presenting symptom in emergency departments, its clinical management is highly variable. Our aims were to describe the characteristics of patients with chest pain and to evaluate the usefulness of the CPU-65 index for risk stratification. The CPU-65 index awards one point for each of the following variables: Comorbid diabetes, typical Pain, Use of aspirin, and age 65 years or more.
  
  
  METHODS
  Details of emergency department patients admitted for nontraumatic chest pain were recorded in a prospective registry.
  
  
  RESULTS
  Over a 3-month period, 1518 patients were admitted with nontraumatic chest pain (6.1% of medical emergencies). Chest pain was classified as nonischemic in 909 patients (59.9%), undefined in 370 (24.4%) and ischemic in 239 (15.7%). An ECG was performed in 1342 patients (88.4%), the troponin-T level was measured in 656 (43.2%), chest radiography was performed in 831 (54.7%), and 385 (25.4%) were evaluated by the cardiologist on duty. Overall, 230 (15.2%) were admitted to hospital; of these, 99 (6.5%) had an acute myocardial infarction (AMI) and seven (0.5%) died during admission. Among patients discharged from the emergency department, the most frequent diagnoses were atypical chest pain (59%) and respiratory infection (12%). The CPU-65 index was associated with the presence of AMI. In total, 50% of patients had a CPU-65 index score of 0, none of whom either had an AMI or died during admission.
  
  
  CONCLUSIONS
  Half of all patients who presented at an emergency department with chest pain were at a very low risk.
authors.affiliation: Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain. mmselles@secardiologia.es
authors.forename: Manuel
authors.initials: M
authors.lastname: Martínez-Sellés
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
authors.forename: Alberto
authors.initials: A
authors.lastname: Sacristán
authors.forename: Alvaro
authors.initials: A
authors.lastname: Estévez
authors.forename: Javier
authors.initials: J
authors.lastname: Ortiz
authors.forename: Laura
authors.initials: L
authors.lastname: Gallego
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment