Chest Pain in the Emergency Department: Causes and ED Disposition

Background: Chest pain is one of the most common reasons to visit the Emergency Department (ED), causes of which include life threatening conditions that need to be identified and stratified early for admission. The objective of this study was to examine the most common causes of chest pain and predictors for admission at an urban, level 1 trauma center. Methods: A retrospective chart review of patients that presented to the ED with a chief complaint of chest pain over a time period of one month was conducted. Data was analyzed using SPSS 16 statistical software. Results: A total of 497 patients were included in the study, 254 (50.4%) were males and 207 (41.1%) were in the age group 45 - 65 years. About 358 (71%) of these patients with acute chest pain were evaluated, treated, and discharged from the emergency department, while 123 (24.4%) of them were admitted. The majority of patients were admitted to the Telemetry unit (80, 65%), and 28 (23%) to regular floors. The most common causes of chest pain in the ED were musculoskeletal-related (252, 50.0%), followed by gastrointestinal causes (58, 11.5%), cardiovascular diseases (45, 8.9%), pulmonary diseases (53, 10.5%), and acute coronary syndrome (both unstable angina and myocardial infarction) represented 48 (9.5%) of the cases. The causes of chest pain varied with age (p = 0.012), sex (p < 0.05) and ED disposition (p < 0.05). Conclusions: Chest pain is a common ED presentation with varied etiologies and outcomes. While musculoskeletal causes are often benign and lead to discharge, acute coronary syndrome and cardiovascular conditions significantly increase the likelihood of admission. Understanding these patterns can improve triage decisions, optimize resource use, and support the development of targeted chest pain management strategies.