Chest pain in daily practice: occurrence, causes and management

Verdon, F; Herzig, Lilli; Burnand, Bernard; Bischoff, Thomas; Pécoud, A; Junod, Michel; Mühlemann, Nicole; Favrat, Bernard; Gmirg,

doi:10.4414/smw.2008.12123

Cited by 35 publications

(7 citation statements)

References 14 publications

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“…The MSK system is accepted as a common cause of chest pain in other studies. 9,18,19 Studies examining the causes of noncardiac chest pain found MSK causes could be responsible for more than 44% of noncardiac chest pain, 7,17 whereas studies examining the causes of general chest pain presentationssimilar to the present studyestimate the prevalence of MSK chest pain between 4% and 30%. 1,3,5 An overall prevalence estimate of 15% aligns well with a recent systematic review estimating the worldwide pooled prevalence of MSK chest pain in EDs to be 16%.…”

Section: Discussionmentioning

confidence: 46%

“…1 Common causes of chest pain include acute coronary syndrome (ACS), oesophageal reflux disorders, panic disorders and musculoskeletal (MSK) causes. [1][2][3][4] MSK causes of chest pain are estimated to represent 4-30% of acute chest pain presentations in EDs, 1,2,5,6 and more than 40% of chest pain presentations in primary care 7,8 although data are limited. Despite being relatively prevalent, MSK chest pain, along with other noncardiac causes of chest pain, Correspondence: Dr Ewan Kennedy, Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin North, Dunedin 9016, New Zealand.…”

Section: Introductionmentioning

confidence: 99%

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Musculoskeletal chest pain prevalence in emergency department presentations: A retrospective case notes review

Dacombe‐Bird,

Dassanayake,

Beck

et al. 2023

Emerg Medicine Australasia

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ObjectiveMusculoskeletal (MSK) causes of chest pain are considered common in emergency care, yet management is limited, reported outcomes are poor and prevalence data in New Zealand are lacking. The present study aims to estimate the prevalence of MSK chest pain in New Zealand EDs and describe the characteristics of MSK chest pain cases.MethodsA retrospective chart review was conducted based on de‐identified clinical notes extracted from four hospitals within the South Island of New Zealand from 3 months spanning 1 March to 31 May 2021. Individual cases were categorised to the single best‐fitting cause of chest pain using systems‐based categorisation, based primarily on the doctors' documented final impression.ResultsA total of 1344 cases were categorised in the present study. MSK chest pain had a prevalence of 15% (range 11–31%) of chest pain presentations across all study sites. This represented the second most common system responsible for chest pain, after the cardiovascular system. The mean age of MSK chest pain cases was 46.9 (standard deviation [SD] 19.1) years, compared to 55.5 (SD 19.7) years in all cases. Age and gender‐specific data, data from rural hospitals and MSK sub‐type data are presented.ConclusionsThese data provide a conservative estimate of MSK chest pain prevalence in EDs within the South Island of New Zealand. The findings highlight MSK chest pain as common in emergency care, providing a basis and justification for further research to improve management and outcomes for people with MSK chest pain.

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Section: Discussionmentioning

confidence: 46%

Section: Introductionmentioning

confidence: 99%

Musculoskeletal chest pain prevalence in emergency department presentations: A retrospective case notes review

Dacombe‐Bird,

Dassanayake,

Beck

et al. 2023

Emerg Medicine Australasia

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“…One exception was patients’ anxiety and subsequent need for reassurance. This is a characteristic that affects the PCPs referral threshold, but is also diagnostic for CAD in primary care [ 3 , 35 ]. In this case, we interpreted the patient’s evaluation of her symptoms as influencing the decision threshold.…”

Section: Discussionmentioning

confidence: 99%

“…In primary care, chest pain is a common symptom with a prevalence of 0.7–2.7% among all patients [ 1 – 3 ]. Underlying diseases are manifold and differ considerably regarding their prognosis.…”

Section: Introductionmentioning

confidence: 99%

Determinants of referral for suspected coronary artery disease: a qualitative study based on decision thresholds

et al. 2023

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Background Chest pain is a frequent consultation issue in primary care, with coronary artery disease (CAD) being a serious potential cause. Primary care physicians (PCPs) assess the probability for CAD and refer patients to secondary care if necessary. Our aim was to explore PCPs’ referral decisions, and to investigate determinants which influenced those decisions. Methods PCPs working in Hesse, Germany, were interviewed in a qualitative study. We used ‘stimulated recall’ with participants to discuss patients with suspected CAD. With a sample size of 26 cases from nine practices we reached inductive thematic saturation. Interviews were audio-recorded, transcribed verbatim and analyzed by inductive-deductive thematic content analysis. For the final interpretation of the material, we used the concept of decision thresholds proposed by Pauker and Kassirer. Results PCPs reflected on their decisions for or against a referral. Aside from patient characteristics determining disease probability, we identified general factors which can be understood as influencing the referral threshold. These factors relate to the practice environment, to PCPs themselves and to non-diagnostic patient characteristics. Proximity of specialist practice, relationship with specialist colleagues, and trust played a role. PCPs sometimes felt that invasive procedures were performed too easily. They tried to steer their patients through the system with the intent to avoid over-treatment. Most PCPs were unaware of guidelines but relied on informal local consensus, largely influenced by specialists. As a result, PCPs gatekeeping role was limited. Conclusions We could identify a large number of factors that impact referral for suspected CAD. Several of these factors offer possibilities to improve care at the clinical and system level. The threshold model proposed by Pauker and Kassirer was a useful framework for this kind of data analysis.

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“…However, in a study of costochondritis in an emergency setting 6% of patients with pain reproduced by chest wall palpation were also diagnosed with myocardial infarction (3). Because the clinical examination lacks specificity, most patients with chest pain still need a thorough evaluation, including electrocardiography at a minimum, to rule out other more serious causes (1,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

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confidence: 99%

Costochondritis syndrome and thoracic-chest related pain: a scoping review

Bolandrini,

Totti,

Segat

et al. 2024

Preprint

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Background: Costochondritis is a frequent diagnosis related to chest pain but the etiology, treatment, and evolution of the disease are poorly documented. Clinical examination lacks specificity and most treatment recommendations are conservative in nature and have been traditionally accepted, perhaps because of the self- limited nature of the condition. However, costochondritis that does not self-resolve is referred to as atypical costochondritis and is associated with high medical expenses and psychological burden on the patient. This scoping review will aim to provide a clear overview about costochondritis, including definitions and terms, signs and symptoms, causes, diagnosis, treatment and prognosis. This work will also aim to propose shareable terms to describe this condition. Inclusion Criteria: Every study describing a condition of non-cardiac musculoskeletal chest pain due to inflammation of the costochondral junctions of ribs or costosternal joints where the areas of tenderness are not generally accompanied by heat, erythema or localized swelling (e.g.,Tietze syndrome). This scoping review will consider studies conducted in any context. Articles in English or Italian will be considered. Methods: The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute methodology (JBI) for scoping reviews. The search will be carried out on 5 databases: MEDLINE, Embase, Cochrane Library, CENTRAL and CINAHL. Addictionally, research protocols will be searched on PROSPERO and ClinicalTrials.gov. Further research of grey literature will be carried out through OpenGrey and Google Scholar. Selection and data extraction will be conducted by two blind independent researchers and inconsistencies will be resolved by a third reviewer. The results will be presented in a schematic, tabular and descriptive format that will line up with the objectives and scope of the review. Conclusions: This scoping review will aim to provide a comprehensive overview of the topic. The results will add meaningful information for clinicians. Furthermore, any knowledge gaps of the topic will be identified.

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Chest pain in daily practice: occurrence, causes and management

Cited by 35 publications

References 14 publications

Musculoskeletal chest pain prevalence in emergency department presentations: A retrospective case notes review

Musculoskeletal chest pain prevalence in emergency department presentations: A retrospective case notes review

Determinants of referral for suspected coronary artery disease: a qualitative study based on decision thresholds

Costochondritis syndrome and thoracic-chest related pain: a scoping review

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