Musey Paul I, Kline Jeffrey A
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
J Emerg Med. 2017 Mar;52(3):273-279. doi: 10.1016/j.jemermed.2016.11.022. Epub 2016 Dec 18.
Chest pain is a high-risk emergency department (ED) chief complaint; the majority of clinical resources are directed toward detecting and treating cardiopulmonary emergencies. However, at follow-up, 80%-95% of these patients have only a symptom-based diagnosis; a large number have undiagnosed anxiety disorders.
Our aim was to measure the frequency of self-identified stress or anxiety among chest pain patients, and compare their pretest probabilities, care processes, and outcomes.
Patients were divided into two groups: explicitly self-reported anxiety and stress or not at 90-day follow-up, then compared on several variables: ultralow (<2.5%) pretest probability, outcome rates for acute coronary syndrome (ACS) and pulmonary embolism (PE), radiation exposure, total costs at 30 days, and 90-day recidivism.
Eight hundred and forty-five patients were studied. Sixty-seven (8%) explicitly attributed their chest pain to "stress" or "anxiety"; their mean ACS pretest probability was 4% (95% confidence interval 2.9%-5.7%) and 49% (33/67) had ultralow pretest probability (0/33 with ACS or PE). None (0/67) were diagnosed with anxiety. Seven hundred and seventy-eight did not report stress or anxiety and, of these, 52% (403/778) had ultralow ACS pretest probability. Only one patient (0.2%; 1/403) was diagnosed with ACS and one patient (0.4%; 1/268) was diagnosed with PE. Patients with self-reported anxiety had similar radiation exposure, associated costs, and nearly identical (25.4% vs. 25.7%) ED recidivism to patients without reported anxiety.
Without prompting, 8% of patients self-identified "stress" or "anxiety" as the etiology for their chest pain. Most had low pretest probability, were over-investigated for ACS and PE, and not investigated for anxiety syndromes.
胸痛是急诊科的高危主诉；大多数临床资源都用于检测和治疗心肺急症。然而，在随访时，这些患者中80%-95%仅有基于症状的诊断；大量患者患有未确诊的焦虑症。
我们的目的是测量胸痛患者中自我认定的压力或焦虑的频率，并比较他们的检验前概率、诊疗过程及结果。
将患者分为两组：在90天随访时明确自我报告有焦虑和压力或无焦虑和压力，然后比较几个变量：超低位（<2.5%）检验前概率、急性冠状动脉综合征（ACS）和肺栓塞（PE）的检出率、辐射暴露、30天总费用以及90天再发率。
共研究了845例患者。67例（8%）明确将其胸痛归因于“压力”或“焦虑”；他们的平均ACS检验前概率为4%（95%置信区间2.9%-5.7%），49%（33/67）有超低位检验前概率（33例中0例患有ACS或PE）。无人（0/67）被诊断为焦虑症。778例未报告有压力或焦虑，其中52%（403/778）有超低位ACS检验前概率。仅1例患者（0.2%；1/403）被诊断为ACS，1例患者（0.4%；1/268）被诊断为PE。自我报告有焦虑的患者与未报告有焦虑的患者辐射暴露、相关费用相似，急诊科再发率几乎相同（25.4%对25.7%）。
在未得到提示的情况下，8%的患者自我认定“压力”或“焦虑”为其胸痛的病因。大多数患者检验前概率较低，对ACS和PE检查过度，而未对焦虑综合征进行检查。
