What Needles Are In My Chest Pain Haystack?

Very very very few disasters, in the end.

Every emergency department visit portends hidden dangers – or, at least, that’s the conventional mindset drilled into trainees and the general culture driven by medicolegal liability.

But how much danger is out there, really?

This is just a retrospective data dredge of triage complaints implicating “atraumatic chest pain” from 141 hospitals staffed by the USACS group. From these 950,000 ED visits, the frequency of associated “life-threatening diagnoses” is as follows:

That is to say, if you see 20 patients a shift, work 15 shifts a month, and work for 20 years – you might see a handful of aortic dissections in your chest pain pile, and may never see the rarer ones.

Of course, there are plenty of limitations to these data – these only represent ED diagnoses, not final diagnoses following admission or further determination, nor do all these diagnoses present solely with “chest pain”. However, as a reasonable starting point in the ballpark of a baseline pretest likelihood of disease, these are fairly reasonable.