Vomiting and indigestion increased ACS odds in Aboriginal and Torres Strait Islander patients, who reported chest pain less (81.5% vs 94.2%) and presented more atypically.
Does symptomatology and the predictive value of specific symptoms for ACS diagnosis differ between Aboriginal/Torres Strait Islander and non-Indigenous patients presenting to the emergency department?
Aboriginal and Torres Strait Islander patients with ACS present less frequently with chest pain and more frequently with gastrointestinal symptoms compared to non-Indigenous patients, indicating that traditional typical/atypical symptom groupings have limited clinical value in this population.
Absolute Event Rate: 0% vs 0%
ABSTRACT Objective To compare the symptomatology of Aboriginal and Torres Strait Islander and non‐Indigenous patients presenting to an emergency department (ED) with suspected acute coronary syndrome (ACS) and to determine whether specific symptoms increased the odds of ACS diagnosis and whether traditional groupings of typical or atypical symptoms are relevant in these populations. Methods Prospectively collected symptom data from 1643 adult patients presenting at two Queensland emergency departments between 2011–2014 and 2016–2019 who were assessed for suspected ACS were analysed according to self‐reported Indigenous status. ACS diagnosis was the primary outcome. Results In 1643 patients investigated for suspected ACS, chest pain (92.1%), diaphoresis (47.8%), and shortness of breath (52.2%) were the most reported symptoms. For the 194 patients diagnosed with ACS, chest pain was reported less frequently in Aboriginal and Torres Strait Islander patients compared with non‐Indigenous patients (81.5% vs. 94.2%, p = 0.009). For Aboriginal and Torres Strait Islander patients, vomiting and indigestion were associated with increased odds of ACS; left‐sided chest pain or sharp pain was associated with decreased odds. Aboriginal and Torres Strait Islander patients with ACS were more likely to present atypically than non‐Indigenous patients, but typicality was not associated with ACS. Conclusion Clinicians must have a high index of suspicion for ACS in Aboriginal and Torres Strait Islander people with chest pain who present with symptoms of gastrointestinal upset such as indigestion or vomiting. Typical or atypical groupings of ACS symptoms are of limited value or relevance in Australian populations, and these terms should be phased out. Trial Registration ANZCRN12617000756325
Stephensen et al. (Sun,) reported a other. Vomiting and indigestion increased ACS odds in Aboriginal and Torres Strait Islander patients, who reported chest pain less (81.5% vs 94.2%) and presented more atypically.
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