Important Components of Medical History in Diagnosing Chest Pain Patients Presenting the Emergency Department

What we aim to determine is which components of medical history, physicians base their first three-way-stratification of chest pain patients on. The three possibilities are aspecific symptoms, atypical angina and typical angina. None of the components of medical history is by itself sufficient in making a just stratification [1]. A certain combination of medical history components could on the other hand be very directive towards a certain preliminary conclusion. Research of scientific literature on widely used risk score models show that little attention is paid to the medical history [1-10]. Often these models rely mostly on findings on the electrocardiogram and biomarkers (troponin, creatinin kinase-myocardial band). The focus of this study lies in unraveling the formation of an initial risk stratification of chest pain patients to achieve a shorter process of illness, a faster shift to appropriate treatment, and an early discharge of patients without suspicion of cardiac disease in the (near) future. To this end a database was build consisting of 255 consecutive chest pain patients presenting the ED. Of every patient all medical history multiple choice questions were digitalized and uploaded in SPSS as single variables. A multinominal logistic regression filtered out the most differentiating variables and after using SPSS cross tabs and an Excel pivot, question clusters were formed for both aspecific symptoms and typical angina. It can be concluded that physicians find it easier to conclude that patients are not suspected of cardiac disease. There are fewer components of medical history that are, according to physicians, clearly pointing towards typical angina. This can be inferred from the fact that when physicians come across a combination of the four main characteristics for patients with aspecific symptoms in over 80% of the cases patients will be said to have aspecific symptoms. Besides the four main characteristics there are eight more characteristics that consolidate this judgment. The characteristics for typical angina are not as numerous. There are only four characteristics significantly differentiating for typical angina and when physicians come across a combination of those, only in more than 67% of the cases patients are said to have typical angina.