Clinical Centre, University of Pécs, Pecs, Hungary.
Gibraltar University, Gibraltar, GX11 1AA, Gibraltar.
BMC Emerg Med. 2021 May 17;21(1):62. doi: 10.1186/s12873-021-00455-x.
Chest pain is one of the commonest presenting complaints in urgent/emergency care, with a lifelong prevalence of up to 25% in the adult population. Pleuritic chest pain is a subset of high investigation burden because of a diverse range of possible causes varying from simple musculoskeletal conditions to pulmonary embolism.
Among otherwise fit and healthy adult patients presenting in our emergency department with sudden onset of unilateral pleuritic chest pain, within 1 month we identified a cohort of five patients with pin-point tenderness in one specific costo-sternal joint often with referred pain to the back. All cases had apparent and, previously undiagnosed mild/moderate scoliosis.
To confirm and validate the observed association between scoliosis and pleuritic chest pain, a retrospective audit was designed and performed using the hospital's electronic medical record system to reassess all consecutive adult chest pain patients.
The Odds Ratio for having chest pain with scoliosis was 30.8 [95%CI 1.71-553.37], twenty times higher than suggested by prevalence data.
In scoliosis the pathologic lateral curvature of the spine adversely affects the functional anatomy of both the spine and ribcage. In our hypothesis the chest wall asymmetry enables minor slip/subluxation of a rib either in the costo-sternal and/or costovertebral junction exerting direct pressure on the intercostal nerve causing pleuritic pain.
Thorough physical examination of the anterior and posterior chest wall is key to identify underlying scoliosis in otherwise fit patients presenting with sudden onset of pleuritic pain. Incorporating assessment for scoliosis in the low-risk chest pain protocols/tools may help reducing the length of stay in the emergency department and, facilitate speedy but safe discharge with increased patient satisfaction.
胸痛是紧急/急诊护理中最常见的主诉之一，成年人终生患病率高达 25%。胸膜炎性胸痛是一种具有高调查负担的亚组，因为可能的病因多种多样，从简单的肌肉骨骼疾病到肺栓塞不等。
在我们的急诊部门，除了健康状况良好的成年患者突然出现单侧胸膜炎性胸痛外，在 1 个月内，我们发现了一组 5 名患者，他们在一个特定的肋胸骨关节处有针尖样压痛，常伴有背部牵涉痛。所有病例均表现出明显且以前未诊断出的轻度/中度脊柱侧弯。
为了确认和验证脊柱侧弯与胸膜炎性胸痛之间的观察到的关联，我们设计并进行了回顾性审核，使用医院的电子病历系统重新评估所有连续的成年胸痛患者。
患有脊柱侧弯的胸痛的优势比为 30.8[95%CI 1.71-553.37]，比患病率数据高出 20 倍。
在脊柱侧弯中，脊柱的病理性侧向弯曲会对脊柱和胸廓的功能解剖产生不利影响。在我们的假设中，胸廓不对称使肋骨在肋胸骨和/或肋椎关节处轻微滑脱/半脱位，直接压迫肋间神经，引起胸膜炎性疼痛。
对健康状况良好的突发胸膜炎性疼痛患者进行前胸壁和后胸壁的彻底体格检查是识别潜在脊柱侧弯的关键。在低风险胸痛方案/工具中纳入对脊柱侧弯的评估可能有助于缩短急诊留观时间，并通过加快但安全的出院来提高患者满意度。
