In Brief: UCSF: Chest Pain May Lead To Overtesting

The vast majority of patients who visit hospital emergency rooms complaining of chest pain are in no danger at all, but often undergo overtesting and other inappropriate utilization of resources, UC San Francisco researchers have concluded.

A new study published in the Journal of the American Medical Association examined 42 million ER patients over a seven-year time period complaining of chest pain. Of those patients, just 5.5% actually had a serious health problem connected to their symptoms. The likelihood of the symptoms being serious increased with the patient's age. Virtually all of the patients had acute coronary syndrome (chest pain is also linked to non-cardiac conditions such as aortic dissection, pulmonary embolism, esophageal rupture, and perforated ulcers).

“Significant diagnostic testing to rule out these diagnoses may not be warranted in a general population of undifferentiated patients,” the authors of the study concluded. They noted that intensive testing of all patients who present with test pain is wasteful, and that diagnostic accuracy of preliminary tests should be improved.

“Because chest pain is a characteristic of several life-threatening conditions and the risks of missing these diagnoses are high, clinicians may overestimate the probability of these conditions,” said lead author, Renee Hsia, MD, MSc, a professor of emergency medicine and health policy at UCSF.