与男性和女性急诊非心源性胸痛错误分类相关的因素。

Factors associated with erroneous emergency department noncardiac chest pain classifications in men and women.

机构信息

Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España.

出版信息

Emergencias. 2022 Aug;34(4):268-274.

Abstract

OBJECTIVES

To analyze the frequency and clinical characteristics associated with erroneous initial classifications of noncardiac chest pain (NCP) in men and women.

MATERIAL AND METHODS

We analyzed all case records in which chest pain was initially classified as noncardiac in origin according to clinical signs and electrocardiograms evaluated in our emergency department between 2008 and 2017. We considered the initial evaluation of NCP to be in error if the final diagnosis was acute coronary syndrome. A risk model for an erroneous initial classification of NCP was developed based on multivariable analysis of our patient data. We also used multivariable analysis to explore associations between 10 clinical signs of chest pain and an erroneous initial NCP classification. The data for men and women were analyzed separately.

RESULTS

NCP was the initial classification for 8093 women; their median (interquartile range) age was 54 (38-73) years. The classification was in error for 72 women (0.9%). Odds ratios (ORs) showed that patient risk factors associated with an erroneous NCP classification in the women in our series were obesity (OR, 0.40; 95% CI, 0.17- 0.97) and cocaine consumption (OR, 5.18; 95% CI, 1.16-23.2). Clinical risk factors associated with erroneous NCP classification in women were recent physical exertion (OR, 2.01; 95% CI, 1.21-3.33), radiation exposure (OR, 2.05; 95% CI, 1.23-3.41), and vegetative symptoms (OR, 1.86; 95% CI, 1.02-3.41). For 9979 men with a median age of 47 (33-64) years, NCP was the initial classification; in 83 of the men (0.8%) the classification was erroneous. Patient factors associated with erroneous NCP classification in men were age over 40 years (OR, 1.74; 95% CI, 1.04-2.91) and hypertension (OR, 0.45; 95% CI, 0.24-0.84). No clinical signs of chest pain in men were associated with error.

CONCLUSION

More clinical characteristics are associated with an erroneous classification of NCP in women. Our findings underline the need to assess the possibility of acute coronary syndrome differently in women, in whom the signs have usually been considered to be atypical.

摘要

目的

分析男性和女性非心源性胸痛（NCP）初始分类错误的频率和临床特征。

材料和方法

我们分析了 2008 年至 2017 年间在我院急诊科根据临床体征和心电图评估最初归类为非心源性胸痛的所有病例记录。如果最终诊断为急性冠状动脉综合征，则认为 NCP 的初始评估有误。根据患者数据的多变量分析，我们建立了一个用于错误初始 NCP 分类的风险模型。我们还使用多变量分析来探讨胸痛的 10 个临床体征与错误初始 NCP 分类之间的关联。分别对男性和女性的数据进行分析。

结果

8093 名女性最初被归类为 NCP；她们的中位（四分位距）年龄为 54（38-73）岁。在我们的研究中，有 72 名女性（0.9%）的分类有误。比值比（OR）表明，与该系列女性中错误的 NCP 分类相关的患者危险因素是肥胖（OR，0.40；95%CI，0.17-0.97）和可卡因使用（OR，5.18；95%CI，1.16-23.2）。与女性错误的 NCP 分类相关的临床危险因素是近期体力活动（OR，2.01；95%CI，1.21-3.33）、辐射暴露（OR，2.05；95%CI，1.23-3.41）和植物神经症状（OR，1.86；95%CI，1.02-3.41）。对于中位年龄为 47（33-64）岁的 9979 名男性，最初分类为 NCP；其中 83 名男性（0.8%）的分类有误。与男性错误的 NCP 分类相关的患者因素是年龄超过 40 岁（OR，1.74；95%CI，1.04-2.91）和高血压（OR，0.45；95%CI，0.24-0.84）。男性胸痛的任何临床体征均与错误无关。