title: Chest pain in primary care: is the localization of pain diagnostically helpful in the critical evaluation of patients?--A cross sectional study.
abstract: BACKGROUND
  Chest pain is a common complaint and reason for consultation in primary care. Traditional textbooks still assign pain localization a certain discriminative role in the differential diagnosis of chest pain. The aim of our study was to synthesize pain drawings from a large sample of chest pain patients and to examine whether pain localizations differ for different underlying etiologies.
  
  
  METHODS
  We conducted a cross-sectional study including 1212 consecutive patients with chest pain recruited in 74 primary care offices in Germany. Primary care providers (PCPs) marked pain localization and radiation of each patient on a pictogram. After 6 months, an independent interdisciplinary reference panel reviewed clinical data of every patient, deciding on the etiology of chest pain at the time of patient recruitment. PCP drawings were entered in a specially designed computer program to produce merged pain charts for different etiologies. Dissimilarities between individual pain localizations and differences on the level of diagnostic groups were analyzed using the Hausdorff distance and the C-index.
  
  
  RESULTS
  Pain location in patients with coronary heart disease (CHD) did not differ from the combined group of all other patients, including patients with chest wall syndrome (CWS), gastro-esophageal reflux disease (GERD) or psychogenic chest pain. There was also no difference in chest pain location between male and female CHD patients.
  
  
  CONCLUSIONS
  Pain localization is not helpful in discriminating CHD from other common chest pain etiologies.
authors.affiliation: Department of General Practice/Family Medicine, Philipps University Marburg, Marburg, Germany. boesner@staff.uni-marburg.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bösner
authors.forename: Katharina
authors.initials: K
authors.lastname: Bönisch
authors.forename: Jörg
authors.initials: J
authors.lastname: Haasenritter
authors.forename: Patrice
authors.initials: P
authors.lastname: Schlegel
authors.forename: Eyke
authors.initials: E
authors.lastname: Hüllermeier
authors.forename: Norbert
authors.initials: N
authors.lastname: Donner-Banzhoff
mesh_terms: D002637:Chest Pain / Q000209:etiology / Q000503:physiopathology*; D015331:Cohort Studies; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis; D008297:Male; D010808:Physical Examination; D011001:Pleuropneumonia / Q000150:complications / Q000175:diagnosis; D011320:Primary Health Care; D011602:Psychophysiologic Disorders / Q000150:complications / Q000175:diagnosis*; D012141:Respiratory Tract Infections / Q000150:complications / Q000175:diagnosis; D013272:Stomach Diseases / Q000150:complications / Q000175:diagnosis; D013898:Thoracic Injuries / Q000150:complications / Q000175:diagnosis; D013991:Tietze's Syndrome / Q000150:complications / Q000175:diagnosis*