title: Chest pain in an out-of-hospital emergency setting: no relationship between pain severity and diagnosis of acute myocardial infarction.
abstract: BACKGROUND
  Chest pain frequently prompts emergency medical services (EMS) call-outs. Early management of acute coronary syndrome (ACS) cases is crucial, but there is still controversy over the relevance of pain severity as a diagnostic criterion.
  
  
  OBJECTIVE
  The aim of this study was to determine whether there is a relationship between the severity of chest pain at the time of out-of-hospital emergency care and diagnosis of acute myocardial infarction (AMI).
  
  
  METHODS
  This was a subsidiary analysis of prehospital data collated prospectively by EMS in a large suburb. It concerned patients with chest pain taken to hospital by a mobile intensive care unit. Pain was rated on EMS arrival using a visual analog, numeric or verbal rating scale and classified on severe or not severe according to the pain score. A diagnosis of AMI was confirmed or ruled out on the basis of 2 plasma troponin measurements and/or coronary angiography results.
  
  
  RESULTS
  Among the cohort of 2,279 patients included, 234 were suitable for analysis, of which 109 (47%) were diagnosed with AMI. The rate of severe pain on EMS arrival was not significantly different between AMI patients and no myocardial infarction patients (49% [95% CI 40 to 58] and 43% [34 to 52], respectively; P = 0.3; odds ratio 1.3 [0.8 - 2.3] after adjustment for age and gender).
  
  
  CONCLUSIONS
  In our out-of-hospital emergency setting, the severity of chest pain was not a useful diagnostic criterion for AMI.
authors.affiliation: AP-HP, CNRD, Hôpital Trousseau, Paris, France; EA 3509, Université Paris 13, Sorbonne Paris Cité, Bobigny, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Galinski
authors.forename: Diane
authors.initials: D
authors.lastname: Saget
authors.forename: Mirko
authors.initials: M
authors.lastname: Ruscev
authors.forename: Geraldine
authors.initials: G
authors.lastname: Gonzalez
authors.forename: Lydia
authors.initials: L
authors.lastname: Ameur
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lapostolle
authors.forename: Frédéric
authors.initials: F
authors.lastname: Adnet
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D012720:Severity of Illness Index
keywords: acute chest pain; acute myocardial infarction; out-of-hospital emergency setting; pain severity