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Observational Study
. 2022 Aug 8;12(8):e054622.
doi: 10.1136/bmjopen-2021-054622.

Clinical presentation in EMS patients with acute chest pain in relation to sex, age and medical history: prospective cohort study

Kristoffer Wibring  1   2 , Markus Lingman  3   4 , Johan Herlitz  5 , Helena Pettersson  2 , Anette Lerjebo  2 , Angela Bång  6
Affiliations
Observational Study

Clinical presentation in EMS patients with acute chest pain in relation to sex, age and medical history: prospective cohort study

Kristoffer Wibring et al. BMJ Open. .

Abstract

Objective: To assess symptom presentation related to age, sex and previous medical history in patients with chest pain.

Design: Prospective observational cohort study.

Setting: Two-centre study in a Swedish county emergency medical service (EMS) organisation.

Participants: Unselected inclusion of 2917 patients with chest pain cared for by the EMS during 2018.

Data analysis: Multivariate analysis on the association between symptom characteristics, patients' sex, age, previous acute coronary syndrome (ACS) or diabetes and the final outcome of acute myocardial infarction (AMI).

Results: Symptomology in patients assessed by the EMS due to acute chest pain varied with sex and age and also with previous ACS or diabetes. Women suffered more often from nausea (OR 1.6) and pain in throat (OR 2.1) or back (OR 2.1). Their pain was more often affected by palpation (1.7) or movement (OR 1.4). Older patients more often described pain onset while sleeping (OR 1.5) and that the onset of symptoms was slow, over hours rather than minutes (OR 1.4). They were less likely to report pain in other parts of their body than their chest (OR 1.4). They were to a lesser extent clammy (OR 0.6) or nauseous (OR 0.6). These differences were present regardless of whether the symptoms were caused by AMI or not.

Conclusions: A number of aspects of the symptom of chest pain appear to differ in unselected prehospital patients with chest pain in relation to age, sex and medical history, regardless of whether the chest pain was caused by a myocardial infarction or not. This complicates the possibility in prehospital care of using symptoms to predict the underlying aetiology of acute chest pain.

Keywords: ACCIDENT & EMERGENCY MEDICINE; Cardiology; General diabetes; Myocardial infarction.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Differences in clinical presentation based on sex.
Figure 2
Figure 2
Differences in clinical presentation based on age.
Figure 3
Figure 3
Differences in clinical presentation based on history of ACS. ACS, acute coronary syndrome.
Figure 4
Figure 4
Differences in clinical presentation based on history of diabetes mellitus.
See this image and copyright information in PMC

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References

    1. Clawson J, Olola C, Heward A, et al. . The medical priority dispatch system's ability to predict cardiac arrest outcomes and high acuity pre-hospital alerts in chest pain patients presenting to 9-9-9. Resuscitation 2008;78:298–306. 10.1016/j.resuscitation.2008.03.229 - DOI - PubMed
    1. Pedersen CK, Stengaard C, Friesgaard K, et al. . Chest pain in the ambulance; prevalence, causes and outcome - a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2019;27:84. 10.1186/s13049-019-0659-6 - DOI - PMC - PubMed
    1. Rawshani A, Larsson A, Gelang C, et al. . Characteristics and outcome among patients who dial for the EMS due to chest pain. Int J Cardiol 2014;176:859–65. 10.1016/j.ijcard.2014.08.004 - DOI - PubMed
    1. Ibanez B, James S, Agewall S. Esc guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of cardiology (ESC). Eur Heart J 20172018;39:119–77. 10.1093/eurheartj/ehx393 - DOI - PubMed
    1. Collet J-P, Thiele H. The 'Ten Commandments' for the 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2020;41:3495–7. 10.1093/eurheartj/ehaa624 - DOI - PubMed

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