چکیده (انگلیسی):

Background:Chest pain is a common diagnostic challenge in primary care and diagnostic measures are often
aimed at confirming or ruling out acute ischaemic heart disease. The aim of this study was to investigate
management of patients with chest pain out-of-hours, including the use of ECG and laboratory tests, assessment of
severity of illness, and the physicians’ decisions on treatment and admittance to hospital.
Methods:Data were registered prospectively from four Norwegian casualty clinics. Data from structured telephone
interviews with 100 physicians shortly after a consultation with a patient presenting at the casualty clinic with
“chest pain” were analysed.
Results:A total of 832 patients with chest pain were registered. The first 100 patients (corresponding doctor-patient
pairs) were included in the study according to the predefined inclusion criteria. Median age of included patients
was 46 years, men constituted 58%. An ECG was taken in 92 of the patients. Of the 24 patients categorised to acute
level of response, 15 had a NACA-score indicating a potentially or definitely life-threatening medical situation. 50
of the patients were admitted to a hospital for further management, of which 43 were thought to have ischaemic
heart disease. Musculoskeletal pain was the second most common cause of pain (n = 22). Otherwise the patients
were thought to have a variety of conditions, most of them managed at a primary care level.
Conclusions:Patients with chest pain presenting at out-of-hours services in Norway are investigated for acute
heart disease, but less than half are admitted to hospital for probable acute coronary syndrome, and only a
minority is given emergency treatment for acute coronary syndrome. A wide variety of other diagnoses are
suggested by the doctors for patients presenting with chest pain. Deciding the appropriate level of response for
such patients is a difficult task, and bothover-andunder-triage probably occur in out-of-hours primary care.