Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Mar 24:15:51.
doi: 10.1186/1471-2296-15-51.

Management of chest pain: a prospective study from Norwegian out-of-hours primary care

Robert Anders Burman  1 , Erik Zakariassen, Steinar Hunskaar
Affiliations

Management of chest pain: a prospective study from Norwegian out-of-hours primary care

Robert Anders Burman et al. BMC Fam Pract. .

Abstract

Background: Chest pain is a common diagnostic challenge in primary care and diagnostic measures are often aimed at confirming or ruling out acute ischaemic heart disease. The aim of this study was to investigate management of patients with chest pain out-of-hours, including the use of ECG and laboratory tests, assessment of severity of illness, and the physicians' decisions on treatment and admittance to hospital.

Methods: Data were registered prospectively from four Norwegian casualty clinics. Data from structured telephone interviews with 100 physicians shortly after a consultation with a patient presenting at the casualty clinic with "chest pain" were analysed.

Results: A total of 832 patients with chest pain were registered. The first 100 patients (corresponding doctor-patient pairs) were included in the study according to the predefined inclusion criteria. Median age of included patients was 46 years, men constituted 58%. An ECG was taken in 92 of the patients. Of the 24 patients categorised to acute level of response, 15 had a NACA-score indicating a potentially or definitely life-threatening medical situation. 50 of the patients were admitted to a hospital for further management, of which 43 were thought to have ischaemic heart disease. Musculoskeletal pain was the second most common cause of pain (n = 22). Otherwise the patients were thought to have a variety of conditions, most of them managed at a primary care level.

Conclusions: Patients with chest pain presenting at out-of-hours services in Norway are investigated for acute heart disease, but less than half are admitted to hospital for probable acute coronary syndrome, and only a minority is given emergency treatment for acute coronary syndrome. A wide variety of other diagnoses are suggested by the doctors for patients presenting with chest pain. Deciding the appropriate level of response for such patients is a difficult task, and both over- and under-triage probably occur in out-of-hours primary care.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow chart of registration of patients and the inclusion process.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bösner S, Becker A, Haasenritter J, Abu Hani M, Keller H, Sönnichsen AC, Karatolios K, Schaefer JR, Seitz G, Baum E, Donner-Banzhoff N. Chest pain in primary care: epidemiology and pre-work-up probabilities. Eur J Gen Pract. 2009;15:141–146. doi: 10.3109/13814780903329528. - DOI - PubMed
    1. Nilsson S, Scheike M, Engblom D, Karlsson LG, Mölstad S, Akerlind I, Ortoft K, Nylander E. Chest pain and ischaemic heart disease in primary care. Br J Gen Pract. 2003;53:378–382. - PMC - PubMed
    1. Burman RA, Zakariassen E, Hunskaar S. Acute chest pain - a prospective population based study of contacts to Norwegian emergency medical communication centres. BMC Emerg Med. 2011;11:9. doi: 10.1186/1471-227X-11-9. - DOI - PMC - PubMed
    1. Ruigómez A, Rodríguez LA, Wallander MA, Johansson S, Jones R. Chest pain in general practice: incidence, comorbidity and mortality. Fam Pract. 2006;23:167–174. - PubMed
    1. Bruyninckx R, Van den Bruel A, Aertgeerts B, Van Casteren V, Buntinx F. Why does the general practitioner refer patients with chest pain not-urgently to the specialist or urgently to the emergency department? Influence of the certainty of the initial diagnosis. Acta Cardiol. 2009;64:259–265. doi: 10.2143/AC.64.2.2036147. - DOI - PubMed

Publication types