Objectives:
Chest pain is among the most common reasons for emergency room presentation. Providing emergency physicians with the tools necessary to evaluate and triage chest pain patients is a key component of health care efficiency. The study objective was to increase understanding of the clinical tools available to evaluate chest pain in the emergency setting.
Methods:
A total of 630 emergency physicians were invited to participate in a web-based survey. Eligible respondents must have had at least 3 years of experience and spend at least 30% of time providing direct patient care. Over the course of 2 days, 163 physicians responded; 101 were eligible and completed the survey. The survey consisted of 3 screening questions and 11 survey questions. Survey questions included: experience with chest pain patients, cardiac imaging technologies as well as knowledge and use of the appropriate use criteria (AUC) for cardiac radionuclide imaging.
Findings:
Over ¾ of all respondents were male, averaged 46 years of age, and had been practicing emergency medicine for nearly 15 years. On average, the respondents saw 20 chest pain patients per week and 72% of those were of unknown cardiac etiology. Diagnostic Catheterization and Stress ECG were the most common evaluation tools available in the emergency department (72% and 71% respectively). When available, stress ECG was the most commonly used evaluation tool in the emergency department. MPI-SPECT was only available to 27% of respondents, and of those, only used 44% of the time. Respondents selecting the “other” response most commonly reported that imaging evaluation was not done in the emergency department. Older physicians (> 61 years) were less likely to report access to stress ECHO; physicians with fewer years of experience (20 or less) were more likely to have access to stress ECHO and diagnostic catheterization. Rural physicians were less likely to report the availability of MPI, CT or diagnostic catheterization. Less than half of emergency physicians (42%) were familiar with the cardiac radionuclide imaging appropriate use criteria, and 80% rarely or never use them. AUC knowledge and use did not differ by years in practice but did differ by age. Physicians in rural practices were the least likely to have knowledge or use the AUC.
Conclusions:
Despite the frequency of chest pain patients presenting to the emergency department, access to imaging tools for evaluation of cardiac etiology is limited. Knowledge and use of AUC guidelines was also limited. These results question the current clinical paradigm which appears to limit the emergency physician knowledge and use of imaging technology to evaluate the chest pain patient despite the high frequency of presentation.
Ability of emergency physicians to diagnose acute coronary syndrome on the ECG of acute chest pain patients