The prevalence of life-threatening diagnoses in emergency department patients with chest pain in a national group

Objective: We describe the prevalence of seven life-threatening diagnoses in Emergency Department (ED) patients with chest pain in a national ED group.

Methods: Using data from 141 EDs staffed by US Acute Care Solutions (USACS) from January 2021 to December 2024 in 17 U.S. states, we used descriptive statistics to tabulate prevalences of seven life-threatening conditions in ED patients with atraumatic chest pain: acute coronary syndrome (ACS), pulmonary embolism (PE), pneumothorax, thoracic aortic dissection (TAD), esophageal rupture, pericardial tamponade, and ruptured aortic aneurysm. We used logistic regression to estimate the association between ACS, PE, or any life-threatening diagnosis with ED visit and site characteristics.

Results: In 13,744,869 ED encounters, 951,152 (6.9%) had a complaint of atraumatic chest pain with 52,410 (5.5%) of these diagnosed with a life-threatening condition in the ED. ACS was most common (4.5%), followed by PE (0.78%), pneumothorax (0.13%), TAD (0.09%), esophageal rupture (0.007%), pericardial tamponade (0.005%), and ruptured aortic aneurysm (0.002%). The prevalence of life-threatening diagnoses was higher in patients who were older, male, covered by commercial insurance, who had higher-acuity triage emergency severity index (ESI) levels, arrived by ambulance, and were seen in western U.S. EDs.

Conclusion: Approximately 1 in 18 ED patients with atraumatic chest pain presents with a life-threatening condition. ACS is the most common followed by PE, pneumothorax and TAD. Other diagnoses are very rare. These data may serve as a priori pre-test probabilities for ED clinicians in the evaluation of chest pain.