Diagnostic approach and relief of acute chest pain in the emergency department

Introduction: Acute Chest Pain (ACP) of non-traumatic etiology is an important diagnostic problem and potentially life-threatening condition for the patient's life and is one of the most frequent causes for patients to arrive in the Emergency Department. Aim: The aim of the present study was to investigate the diagnostic and analgesic approach for the diagnosis and treatment of acute chest pain of non-traumatic etiology for patients presenting to the Emergency Department (ED). Material and Method: The studied sample consisted of 70 patients out of a population of 932 civilians attending the ED of a major General Hospital of Athens with main symptom of ACP, on general duty days over a 30-day period. Demographics, clinical findings, results of laboratory and imaging examinations, analgesic and other medications, and their outcome in the ED were recorded. The SPSS 21.0 statistical package was used to analyze the data. Results: Fifty-eight point six per cent of the sample consisted of male patients. The most frequent diagnoses were serious cardiovascular problems (40%), musculoskeletal disorders (24.3%) and psychological/psychiatric disorders (10%). Among those with serious cardiovascular problems the majority was diagnosed with acute myocardial infarction (57.1%). In most patients, ECG (98.6%), general blood (95.75%), cardiac ultrasound (77.1%) and troponin control (85.7%) were performed. At the present study, only 15.8% of patients received analgesics, despite the fact that they reported average pain (score 6.7 out of 10) on their arrival to the ED. However, a reduction of chest pain at exit from the ED was recorded, with an average score of 4.4, even at patients who did not receive any drug intervention. There were no differences in the diagnostic process, the character, the duration before the arrival and pain intensity in relation to gender. Also, there was no statistically significant relationship between the pain intensity score reported by the patient and the administration of analgesic treatment. However, the average time of administration of analgesic therapy to those who received was 25.9 minutes after arrival to the ED. The average waiting time in the EDF was 196.9 minutes. Conclusions: Although the diagnostic approach of the ACP appeared to follow clinical guidelines, this was not the case with the administration of analgesia based on pain intensity. Guidelines on pain management were not followed and fewer patients received analgesia.

Keywords: Acute chest pain, emergency department, pain management, pain, analgesia