Analysis of factors affecting emergency physicians' decisions in the management of chest pain patients

Objective The aim of this study was to determine the factors most affecting emergency physicians' decisions in the management of chest pain patients. Methods This prospective randomized cross-sectional study was carried out between March 2004 and September 2004 in an urban university hospital emergency department. Residents collected data on patients' demographic features, chest pain characteristics, electrocardiography, cardiac enzymes and outcome of patients. Results Five hundred and sixty-two patients were enrolled in the study; 389 (69.2%) patients were classified as having cardiac chest pain. Of the 389 patients suggested to have cardiac chest pain, 369 (94.4%) were classified as probable acute coronary syndrome; 286 (50.9%) patients were seen by cardiologists and 187 (33.3%) were admitted to the cardiology ward. The logistic regression analysis revealed that angina equivalents (P < 0.001), age (P = 0.002), history of coronary artery disease (P = 0.003), electrocardiography (P = 0.001), substernal chest pain (P = 0.001), typical chest pain (P = 0.000) and radiation of chest pain (P = 0.039) were independent factors affecting emergency physicians' decisions. Conclusion The factors affecting emergency physicians' decisions are correlated with guidelines. (C) 2006 Lippincott Williams & Wilkins.