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September 1, 1993Emergency Medicine JournalOpen Access

Audit of patients with chest pain presenting to an accident and emergency department over a 6-month period.

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Population

Patients presenting with chest pain to an accident and emergency (A&E) department over a 6-month period.

Design

Cohort

Authors

NFN J FothergillSt. Mary’s HospitalMHM T HuntKing's College - North CarolinaRTRobin TouquetOxfam

Discussion

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Implication

Most chest pain patients are discharged by emergency physicians without referral; observational data leaves open whether broader specialist input reduces missed cardiac events.

Key Points

  • To examine diagnostic coding, specialist referral practices, and discharge dispositions for patients presenting to the emergency department with chest pain, particularly regarding acute myocardial infarction and unstable angina.
  • Conducted a 6-month retrospective clinical audit in an accident and emergency department with an annual volume of 46,000 new patients.
  • Analyzed diagnostic codes assigned by emergency physicians, referral rates to internal medicine or cardiology, and patient disposition.
  • Overall, 61% of patients presenting with chest pain across all etiologies were evaluated and discharged home directly by emergency physicians without requesting a second opinion.
  • Among patients suspected of having cardiac chest pain who were referred to a duty medical registrar or cardiologist, 88% were admitted to the hospital.

Structured PICO

P
Population
Patients presenting with chest pain to an accident and emergency (A&E) department over a 6-month period.
O
Outcome
Referral rates for second opinion and disposal after assessment in the A&E department

A significant proportion of chest pain patients are discharged without a second opinion, prompting a policy change for more open referral to avoid missing serious cardiac pathology.

Cite This Study

Fothergill et al. (1993) studied this question.

synapsesocial.com/papers/6a73dc67d080559b4669f518https://doi.org/10.1136/emj.10.3.155
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1A Computer-Derived Protocol to Aid in the Diagnosis of Emergency Room Patients with Acute Chest Pain1982 · 506 citations
  2. 2Prognosis of patients with "chest pain ?cause".1981 · 68 citations
  3. 3Predictors of myocardial infarction in emergency room patients1985 · 133 citations
  4. 4First electrocardiogram in recent myocardial infarction.1976 · 100 citations
  5. 5'Esophageal Angina' as the Cause of Chest Pain1982 · 105 citations