• Chest Pain in an Out-of-Hospital Emergency Setting: No Relationship Between Pain Severity and Diagnosis of Acute Myocardial Infarction

    by Alan Batt. Last modified: 06/04/14

    acs

    Summary

    • Cohort study, subsidiary analysis of prehospital data collated by EMS
    • 234 eligible patients from 2,279 sample size
    • 109 diagnosed with AMI (47%)
    • Pain was defined as severe if the VAS or NRS was ≥ 6/10 or the VRS was equal to 4.
    • The rate of severe pain on EMS arrival was not significantly different between AMI patients and no myocardial infarction patients
    • Severity of chest pain is not a useful diagnostic criterion for AMI.

    Limitations

    • Data missing for 70 patients
    • Selection bias due to lack of follow-up of some patients  (inherent to the method used for this study)
    • Relies on self-reported data from patients, patients with inability to perform a self-assessment (vital distress, central neurological disease, behavioral disorders, disorder of upper functions, inability to communicate), or a language barrier were excluded
     
    Galinski M1, Saget D, Ruscev M, Gonzalez G, Ameur L, Lapostolle F, Adnet F. Chest Pain in an Out-of-Hospital Emergency Setting: No Relationship Between Pain Severity and Diagnosis of Acute Myocardial Infarction. Pain Pract. 2014 Mar 20. PMID: 24646436.

    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.

    Objectives

    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.

    References

     
    1.

    Galinski M1, Saget D, Ruscev M, Gonzalez G, Ameur L, Lapostolle F, Adnet F. Chest Pain in an Out-of-Hospital Emergency Setting: No Relationship Between Pain Severity and Diagnosis of Acute Myocardial Infarction. Pain Pract. 2014 Mar 20. PMID: 24646436.

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    Alan Batt

    Alan Batt

    Paramedic, educator, researcher
    Alan is a critical care paramedic, paramedic educator and prehospital researcher, currently working around the world as an educator and researcher. He has previously worked and studied across Europe, North America and the Middle East. He holds a Graduate Certificate in Intensive Care Paramedic Studies, and an MSc in Critical Care. His main interests are in care of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education.

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