#28 Needle in the haystack. The impact of chest pain presentations on a model 4 emergency department

<h3>Introduction</h3> Chest pain is a frequent presenting complaint to the Emergency Department (ED) with a range of underlying pathology. Both patient and clinician concern often focuses on ruling out acute coronary syndrome (ACS), and given the risk of this, it is imperative that these presentations are triaged and assessed in a timely manner. The aim of this study is to identify key trends in chest pain presentations and management, and to describe the incidence of ACS, the ‘needle in the haystack’. <h3>Methods</h3> This was a retrospective study, examining data from a 14-day period in November 2023. The study population included all presentations over 16 years, who self-presented or were referred by their GP, to the ED where ‘chest pain’ was included in the triage note. Triage notes where ‘chest pain’ was referred to in the negative were excluded. Data was collected from digital healthcare records. <h3>Results</h3> 118 presentations met the inclusion criteria for analysis. The median age was 48 years (range 16-91) and 50% (N=59) were male. The most common triage category allocation was C3, and the median time to triage was 33 minutes (Range 5-151). 80% of cases had an ECG with Troponin measurements in 79%. Three cases (2.5%) of ACS were identified with all diagnoses described in figure 1. 8.5% of cases (N=10) were referred to Cardiology for admission with a further 9.3% (n=11) admitted by other specialities. <h3>Conclusion</h3> Chest pain is common, but the incidence of ACS is low. Despite this, these presentations result in significant use of ED resources making it difficult to achieve recognised assessment targets such as ‘Time to ECG.’ A cautious but judicious approach to chest pain with senior decision makers is encouraged to utilise resources appropriately and to make appropriate decisions regarding chest pain presenting to the ED.