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Symptom description in patients with chest pain-A qualitative analysis of emergency medical calls involving high-risk conditions

Journal article
Authors Kristoffer Wibring
J. Herlitz
Markus Lingman
Angela Bång
Published in Journal of Clinical Nursing
Volume 28
Issue 15-16
Pages 2844-2857
ISSN 0962-1067
Publication year 2019
Published at Institute of Medicine, Department of Public Health and Community Medicine
Institute of Health and Care Sciences
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 2844-2857
Language en
Links dx.doi.org/10.1111/jocn.14867
Keywords chest pain, emergency medical dispatch, emergency medical services, patient assessment, patient experience, prehospital, risk assessment, symptoms, acute myocardial-infarction, prehospital experiences, decision-making, predict, care, Nursing
Subject categories Cardiac and Cardiovascular Systems

Abstract

Aims and objectives To explore the symptoms descriptions and situational information provided by patients during ongoing chest pain events caused by a high-risk condition. Background Chest pain is a common symptom in patients contacting emergency dispatch centres. Only 15% of these patients are later classified as suffering from a high-risk condition. Prehospital personnel are largely dependent on symptom characteristics when trying to identify these patients. Design Qualitative descriptive. Methods Manifest content analysis of 56 emergency medical calls involving patients with chest pain was carried out. A stratified purposive sampling was used to obtain calls concerning patients with high-risk conditions. These calls were then listened to and transcribed. Thereafter, meaning units were identified and coded and finally categorised. Consolidated criteria for reporting qualitative studies guidelines have been applied. Results A wide range of situational information and symptoms descriptions was found. Pain and affected breathing were dominating aspects, but other situational information and several other symptoms were also reported. The situational information and these symptoms were classified into seven categories: Pain narrative, Affected breathing, Bodily reactions, Time, Bodily whereabouts, Fear and concern and Situation management. The seven categories consisted of 17 subcategories. Conclusions Patients with chest pain caused by a high-risk condition present a wide range of symptoms which are described in a variety of ways. They describe different kinds of chest pain accompanied by pain from other parts of the body. Breathing difficulties and bodily reactions such as muscle weakness are also reported. The variety of symptoms and the absence of a typical symptomatology make risk stratification on the basis of symptoms alone difficult. Relevance to clinical practice This study highlights the importance of an open mind when assessing patients with chest pain and the requirement of a decision support tool in order to improve risk stratification in these patients.

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