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IntroductionAortic dissection is a rare event. While the most frequent symptom is chest pain, that is a common emergency department (ED) chief complaint and other diseases causing chest pain occur much more often. Furthermore, 20% of dissections are without chest pain and 6% are painless. For these reasons, diagnosing dissections may be challenging. Our goal was to determine the number of total ED and atraumatic chest pain patients for every aortic dissection diagnosed by emergency physicians.MethodsDesign: Retrospective cohort. Setting: 33 suburban and urban New York and New Jersey EDs with annual visits between 8,000 and 80,000. Participants: Consecutive patients seen by emergency physicians from 1-1-1996 through 12-31-2010. Observations: We identified aortic dissection and atraumatic chest pain patients using the International Classification of Diseases 9th Revision and Clinical Modification codes. We then calculated the number of total ED and atraumatic chest pain patients for every aortic dissection, along with 95% confidence intervals (CIs).ResultsFrom a database of 9.5 million ED visits, we identified 782 aortic dissections or one for every 12,200 (95% CI [11,400–13,100]) visits. The mean age of dissection patients was 66±16 years and 38% were female. There were 763,000 (8%) with atraumatic chest pain diagnoses. Thus, there is one dissection for every 980 (95% CI [910–1,050]) atraumatic chest pain patients.ConclusionThe diagnosis of aortic dissections by emergency physicians is rare and challenging. An emergency physician seeing 3,000 to 4,000 patients a year would diagnose an aortic dissection approximately every three to four years.

Abstract. Objective: To define the prevalence of smokers and nicotine-addicted patients in a suburban, community ED. Methods: This was a prospective survey of consecutive ED patients seen in a suburban ED with an annual patient census of 48,000. Medically stable patients aged 18 years or older were eligible for inclusion. Patients were excluded if they had predominantly psychiatric complaints or were critically ill. Patients were queried about their smoking habits by a closed-question survey, which included the previously validated Fagerstrom Test for Nicotine Dependence. The study was conducted during a six-week period, only at times when there were dedicated research associates available to ensure consecutive patient entry. Continuous variables were analyzed by Student's t-tests. Clinical variables were analyzed by chi-square tests. All tests were two-tailed with alpha at 0.05. Results: 1,515 patients comprised the study group. The mean age (ϮSD) was 45.6 (Ϯ18.9) years; 52% were female, 25% were nonwhite, and 47% were college graduates. There were 317 (21%) smokers. Patients having private physicians were less likely to smoke (18% vs 29%, p = 0.001). Of all smokers, 46% were moderately to severely nicotine-dependent, 69% wanted to quit, and 30% expressed an interest in joining a smoking cessation program. Conclusion: A substantial percentage of ED patients smoke, many of them are nicotine-addicted, and the majority would like to quit. Randomized, controlled trials are needed to determine whether interventions by physicians in the ED can have an impact on the smoking habits of these patients. Key words: smoking; cigarettes; smoking prevention; emergency department; nicotine addiction. ACADEMIC EMER-GENCY MEDICINE 1999; 6:807-810 E MERGENCY physicians have begun to recognize the role of the ED as an important setting for health promotion and disease prevention.1 More than 90 million visits to EDs occur annually in the United States.2 Each visit represents an opportunity for caregivers to provide counseling and screening of patients on various lifestyle and other health issues. In fact, studies have already evaluated the role of the ED for such public health measures as immunization screening, Pap tests, and blood lead-level testing. 3-5Cigarette smoking represents a major public health problem in the United States. In 1990, an estimated 420,000 Americans died as a result of smoking. 6 The United States pays an estimated $65 billion annually in medical care and indirect costs to treat tobacco users, a tremendous strain Development of new strategies to reduce the number of smokers in this country could have a dramatic impact in reducing health care expenditures.Two recent studies suggest that the ED may be an underutilized forum for smoking cessation intervention measures. Lowenstein et al. found that 41% of their urban-based ED population were smokers. Furthermore, of those subjects who smoked, 68% stated that they wanted to quit. These prior studies of ED patients' smoking habits were limited by small sample s...