title: The challenge of triaging chest pain patients: the bernese university hospital experience.
abstract: 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.
authors: Department of Emergency Medicine, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
authors: Martin
authors: M
authors: Rohacek
authors: Amina
authors: A
authors: Bertolotti
authors: Nadine
authors: N
authors: Grützmüller
authors: Urs
authors: U
authors: Simmen
authors: Hans
authors: H
authors: Marty
authors: Heinz
authors: H
authors: Zimmermann
authors: Aristomenis
authors: A
authors: Exadaktylos
authors: Arampatzis
authors: A
authors: Spyridon