Chest Pain Among Adults Presenting at the A&E Department of a Public Tertiary Health Care Institution During a 2-Year Period
- AIOR Admin
- 12 hours ago
- 2 min read
Mandreker Bahall, George Legall
University of the West Indies, Trinidad and Tobago
Evaluating chest pain is challenging due to the because of urgency of its management, resource constraints in highly stressful environments, inadequate information, and inexperienced clinical staff. The aim of this study was to examine the emergency diagnosis, presenting symptoms, treatment, and dispatch of adult patients with chest pain at the emergency department of a public healthcare institution in Trinidad and Tobago over a 2-year period. The target population comprised individuals at least 18 years old presenting with chest pain at the emergency department of a public health care institute in Trinidad and Tobago. Data were obtained solely from accident and emergency (A&E) records, including special notes when applicable, and were analyzed with SPSS version 23 (IBM, Armonk, New York, NY, USA) using descriptive and inferential statistics. Patients were primarily mainly female (n = 1058, 51.2%) and Indo-Trinbagonian (n = 1174; 56.8%). The mean age was 53.4 years (standard deviation [SD] =16.76); with more than two-fifths in the 45–64 age group (n =876, 42.3%). Hypertension (n = 941, 45.5%) was the leading comorbidity, followed by diabetes (n = 658, 31.8%) and ischemic heart disease (IHD) (n = 541, 26.3%). Only 13.3% (n=274) smoked, 8.8% (n= 181) used alcohol. Presenting symptoms were due to shortness of breath (n= 875, 42.3%), nausea (n = 417, 20.2%), and palpitations (n = 364, 17.6%). Twenty-two (1.1%) patients presented with atypical chest pain and 103 (5.0%), with classical chest pain. Among the entire sample, medical diagnoses were muscular pain (n = 86, 4.2%), followed by GERD (n = 48, 2.3%), and acute coronary syndrome (ACS) (n = 77, 3.7%). Pulmonary embolism and aortic dissection occurred in 1 and 0 patients, respectively. Most patients (n = 1899, 91.8%) had no documented diagnosis. Among the 228 (11.0%) patients triaged, the mean hours were 20.1 (SD =7.38). Post-triage treatments included aspirin (n = 482, 23.3%), clopidogrel (n = 450, 21.8%) and heparin (n=456, 22%). Most (n=1179, 57%) participants had no dispatch documentation; 24.4% (n = 505) were dispatched to the medical ward and 1.7% (n=35) were dispatched to the cardiac ward. Chest pain due to ACS accounted for 3.7% of cases (n = 77). Approximately one-quarter of patients were treated with one antiplatelet (n = 482, 23.3%). A sizeable proportion of patients was without clear documentation of diagnosis (n = 1899, 91.8%) or dispatch (n = 1179, 57.0%). The implementation of standardized clinical pathways and templates within a dedicated chest pain evaluation area is essential for optimizing care, ensuring timely treatment, and following noncardiac cases.
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