title: Acute fatal chest pain: optimized procedure in emergency department.
abstract: OBJECTIVE
  To explore the diagnostic procedure of acute fatal chest pain in emergency department (ED) in order to decrease the misdiagnosis rate and shorten the definite time to diagnosis. The ultimate aim is to rescue the patients timely and effectively.
  
  
  METHODS
  Three hundreds and two patients (56.9 ± 11.8 Years, 72% men) complained with acute chest pain and chest distress presenting to our ED were recruited. They were divided into two groups according to visiting time (Group I: from October 2010 to March 2011, Group II: from October 2011 to March 2012). The misdiagnosis rate, definite time for diagnosis and medical expense were analyzed. Patients of Group I were diagnosed by initial doctors who made their diagnosis according to personal experience in outpatient service or rescue room in ED. While patients of Group II were all admitted to rescue room and were diagnosed and rescued according to the acute chest pain screening flow-process diagram. Differences inter-group was compared.
  
  
  RESULTS
  The misdiagnosis rate of fatal chest pain in Group I and Group II was 6.8% and 0% respectively, and there was statistic difference (P=0.000). The definite time to diagnosis was 65.3 min and 40.1 min in control and Group II respectively, the difference had statistic significance (P=0.000). And the mean cost for treatment was 787.5/124.5 ¥/$ and 905.5/143.2 ¥/$ respectively, and there was statistic difference too (P=0.012).
  
  
  CONCLUSIONS
  Treating emergency patients with acute chest pain according to the acute chest pain screening flow-process diagram in rescue room will decrease misdiagnosis apparently, and it can also shorten the definite time to correct diagnosis. It has a remarkable positive role in rescuing patients with acute chest pain timely and effectively.
authors.affiliation: Department of emergency, Fuzhou general hospital of Nanjing military command, Fuzhou 350025, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.forename: Ming
authors.initials: M
authors.lastname: Peng
authors.forename: Lianying
authors.initials: L
authors.lastname: Tong
authors.forename: Shouyu
authors.initials: S
authors.lastname: Lin
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D003951:Diagnostic Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014218:Triage / Q000379:methods; D057188:Workflow; D055815:Young Adult