Musey Paul I, Lee John A, Hall Cassandra A, Kline Jeffrey A
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
University of Virginia School of Medicine, Charlottesville, Virginia, 22908, USA.
BMC Emerg Med. 2018 Mar 14;18(1):10. doi: 10.1186/s12873-018-0161-x.
Approximately 80% of patients presenting to emergency departments (ED) with chest pain do not have any true cardiopulmonary emergency such as acute coronary syndrome (ACS). However, psychological contributors such as anxiety are thought to be present in up to 58%, but often remain undiagnosed leading to chronic chest pain and ED recidivism.
To evaluate ED provider beliefs and their usual practices regarding the approach and disposition of patients with low risk chest pain associated with anxiety, we constructed a 22-item survey using a modified Delphi technique. The survey was administered to a convenience sample of ED providers attending the 2016 American College of Emergency Physicians Scientific Assembly in Las Vegas.
Surveys were completed by 409 emergency medicine providers from 46 states and 7 countries with a wide range of years of experience and primary practice environment (academic versus community centers). Respondents estimated that 30% of patients presenting to the ED with chest pain thought to be low risk for ACS have anxiety or panic as the primary cause but they directly communicate this belief to only 42% of these patients and provide discharge instructions to 48%. Only 39% of respondents reported adequate hospital resources to ensure follow-up. Community-based providers reported more adequate follow-up for these patients than their academic center colleagues (46% vs. 34%; p = 0.015). Most providers (82%) indicated that they wanted to have referral resources available to a specific clinic for further outpatient evaluation.
Emergency Department providers believe approximately 30% of patients seeking emergency care for chest pain at low risk for ACS have anxiety as a primary problem, yet fewer than half discuss this concern or provide information to help the patient manage anxiety. This highlights an opportunity for patient centered communication.
因胸痛前往急诊科（ED）就诊的患者中，约80%并无诸如急性冠状动脉综合征（ACS）等真正的心肺急症。然而，据认为焦虑等心理因素在这类患者中占比高达58%，但往往未被诊断出来，从而导致慢性胸痛和急诊科复诊。
为评估急诊科医护人员对于伴有焦虑的低风险胸痛患者的处理方式和处置的看法及惯常做法，我们采用改良德尔菲技术构建了一份包含22个条目的调查问卷。该问卷被发放给参加2016年在拉斯维加斯举行的美国急诊医师学会科学大会的急诊科医护人员这一便利样本群体。
来自46个州和7个国家的409名急诊医学医护人员完成了调查，他们有着广泛的工作年限以及多元化的主要执业环境（学术中心与社区中心）。受访者估计，因胸痛前往急诊科就诊且被认为ACS风险较低的患者中，有30%以焦虑或恐慌为主要病因，但他们仅将这一看法直接告知了其中42%的患者，且向48%的患者提供了出院指导。只有39%的受访者报告称医院有足够资源确保后续跟进。与学术中心的同事相比，社区医疗机构的医护人员报告对这类患者的后续跟进更为充分（46%对34%；p = 0.015）。大多数医护人员（82%）表示希望有可转介至特定诊所进行进一步门诊评估的资源。
急诊科医护人员认为，约30%因胸痛寻求急诊治疗且ACS风险较低的患者主要问题是焦虑，但不到半数的医护人员会讨论这一问题或提供有助于患者应对焦虑的信息。这凸显了以患者为中心进行沟通的机会。
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