Christ M, Dormann H, Enk R, Popp S, Singler K, Müller C, Mang H
Klinik für Notfall- und Internistische Intensivmedizin, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland,
Med Klin Intensivmed Notfmed. 2014 Oct;109(7):495-503. doi: 10.1007/s00063-013-0342-z. Epub 2014 Oct 15.
A large number of patients present to the emergency department (ED) for evaluation of acute chest pain. About 10-15% are caused by acute myocardial infarction (MI), and over 50% of cases are due to noncardiac reasons. Further improvement for chest pain evaluation appears necessary.
What are current options to improve chest pain evaluation in Germany?
A selective literature search was performed using the following terms: "chest pain", "emergency department", "acute coronary syndrome" and "chest pain evaluation".
A working group of the German Society of Cardiology published recommendations for infrastructure, equipment and organisation of chest pain units in Germany, which should be separated from the ED of hospitals and be under the leadership of a cardiologist. A symptom-based decision for acute care would be preferable if all differential diagnoses of diseases could be managed by one medical specialty: However, all four main symptoms of patients with acute MI (chest pain, acute dyspnea, abdominal pain, dizziness) are also caused by diseases of different specialties. Evaluation and treatment of acute chest pain by representatives of one specialty would lead to over- or undertreatment of affected patients. Therefore we suggest a multidisciplinary evaluation of patients with acute chest pain including representatives of emergency and critical care physicians, cardiologists, internists, geriatricians, family physicians, premedics and emergency nurses. Definition of key indicators of performance and institutionalized feedback will help to further improve quality of care.
大量患者前往急诊科评估急性胸痛。约10%-15%由急性心肌梗死（MI）引起，超过50%的病例是由非心脏原因导致。胸痛评估似乎有必要进一步改进。
德国目前有哪些改善胸痛评估的方法？
使用以下术语进行选择性文献检索：“胸痛”“急诊科”“急性冠状动脉综合征”和“胸痛评估”。
德国心脏病学会的一个工作组发布了关于德国胸痛单元的基础设施、设备和组织的建议，胸痛单元应与医院急诊科分开，并由心脏病专家领导。如果所有疾病的鉴别诊断都能由一个医学专科处理，基于症状的急性护理决策会更好：然而，急性心肌梗死患者的所有四个主要症状（胸痛、急性呼吸困难、腹痛、头晕）也可由不同专科的疾病引起。由一个专科的代表对急性胸痛进行评估和治疗会导致受影响患者的治疗过度或不足。因此，我们建议对急性胸痛患者进行多学科评估，包括急诊和重症护理医生、心脏病专家、内科医生、老年病专家、家庭医生、急救人员和急诊护士的代表。定义关键绩效指标并建立制度化反馈将有助于进一步提高护理质量。
