2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T65c,We describe the prevalence of seven life-threatening diagnoses in Emergency Department (ED) patients with chest pain in a national ED group. Using data from 141 EDs staffed by US Acute Care Solutions (USACS) from January 2021 to December 2024 in 17 U.S. states, we used descriptive statistics to tabulate prevalences of seven life-threatening conditions in ED patients with atraumatic chest pain: acute coronary syndrome (ACS), pulmonary embolism (PE), pneumothorax, thoracic aortic dissection (TAD), esophageal rupture, pericardial tamponade, and ruptured aortic aneurysm. We used logistic regression to estimate the association between ACS, PE, or any life-threatening diagnosis with ED visit and site characteristics. In 13,744,869 ED encounters, 951,152 (6.9%) had a complaint of atraumatic chest pain with 52,410 (5.5%) of these diagnosed with a life-threatening condition in the ED. ACS was most common (4.5%), followed by PE (0.78%), pneumothorax (0.13%), TAD (0.09%), esophageal rupture (0.007%), pericardial tamponade (0.005%), and ruptured aortic aneurysm (0.002%). The prevalence of life-threatening diagnoses was higher in patients who were older, male, covered by commercial insurance, who had higher-acuity triage emergency severity index (ESI) levels, arrived by ambulance, and were seen in western U.S. EDs. Approximately 1 in 18 ED patients with atraumatic chest pain presents with a life-threatening condition. ACS is the most common followed by PE, pneumothorax and TAD. Other diagnoses are very rare. These data may serve as a priori pre-test probabilities for ED clinicians in the evaluation of chest pain.31:T572,ABSTRACT Objective We sought to identify predictor variables for a future clinical decision rule for CXR ordering in non‐traumatic chest pain. Methods Emergency Medicine Physicians were asked to select variables that would result in a CXR being ordered. Inter‐rater reliability (using Fleiss' kappa) was calculated for the most commonly agreed upon. Results Of the 40 candidate variables, 10 were most agreed upon; however, only three had perfect inter‐rater agreement and reliability. Conclusions In this study, only an abnormal lung examination, a suspicion of pneumonia or of acute pulmonary oedema had perfect inter‐rater agreement and reliability. Further research is required on a larger scale to refine and identify the optimal candidate variables for inclusion in a clinical decision rule. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Chest Pain: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Chest Pain (condition). Clinician-written summaries and actionable practice insights. Updated daily.\",\"url\":\"https://www.reachrx.ai/hub/tag/condition/Chest%20Pain\",\"breadcrumb\":{\"@type\":\"BreadcrumbList\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https://www.reachrx.ai\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Research Hub\",\"item\":\"https://www.reachrx.ai/hub\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Conditions\",\"item\":\"https://www.reachrx.ai/hub/tag/condition\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Chest Pain\",\"item\":\"https://www.reachrx.ai/hub/tag/condition/Chest%20Pain\"}]}}"}}]],["$","$L2f",null,{"title":"Chest Pain: Research & Clinical Takeaways","description":"Discover peer-reviewed research on Chest Pain with concise clinician summaries and next-step guidance.","papers":[{"doi":"10.1080/10903127.2026.2677853","pmid":"42213793","title":"External Validation of the SCARE Score for Predicting Acute Myocardial Infarction in Patients Calling Emergency Medical Communication Centers: A Prospective Multicenter Study","journal_title":"Prehospital Emergency Care","journal_issn":"1090-3127","published_at":"2026-06-04T00:00:00.000Z","url":"https://doi.org/10.1080/10903127.2026.2677853","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-06T13:36:17.949Z","updated_at":"2026-07-06T13:36:17.949Z","tags":[{"paper_doi":"10.1080/10903127.2026.2677853","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2677853","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2677853","tag_type":"condition","value":"Acute Myocardial Infarction","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2677853","tag_type":"condition","value":"Chest Pain","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2677853","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2677853","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2677853","tag_type":"modality","value":"Clinical Decision Score","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2677853","tag_type":"modality","value":"Emergency Medical Dispatch","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2677853","tag_type":"sample_size","value":"n=2042","value_numeric":2042},{"paper_doi":"10.1080/10903127.2026.2677853","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2677853","tag_type":"study_design","value":"Prospective Observational Multicenter Study","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2677853","tag_type":"warning","value":"Sex-stratified AUROC difference (women 0.89 vs. men 0.84) is statistically significant but the clinical implication is not fully explored in the abstract.","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2677853","tag_type":"warning","value":"The SCARE score was reconstructed retrospectively and was not available to dispatchers in real time; prospective operational performance may differ.","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2677853","tag_type":"warning","value":"The study population is limited to hospitalized patients, creating a significant selection bias — callers who were not admitted are excluded, which inflates AMI prevalence (13%) and may overestimate score performance in the broader population of all chest pain callers.","value_numeric":null}],"summaries":{"what_studied":"External validation of the SCARE score for predicting acute myocardial infarction (AMI) among 2,042 adults hospitalized after calling one of four French physician-staffed Emergency Medical Communication Centers (EMCCs) for non-traumatic chest pain (October 2019–February 2020), with secondary sex-stratified analyses.","key_result":"The SCARE score showed good discrimination (AUROC 0.85, 95% CI 0.82–0.87). At the >35-point high-risk threshold: sensitivity 73.6%, specificity 75.3%, NPV 95.0%, PPV 30.8%. AMI prevalence ranged from 2.4% (low-risk) to 31.0% (high-risk). Women had a significantly higher AUROC (0.89) than men (0.84; p = 0.006).","limitations":"- Study enrolled only hospitalized patients, excluding all callers not admitted — likely overestimates AMI prevalence and limits generalizability to all chest pain callers.\n- Score was reconstructed retrospectively from prospectively collected variables; it was not used in real time, so its operational impact on dispatch is untested.\n- Validation is specific to French physician-staffed dispatch systems; applicability to non-physician dispatch centers is unknown.","practice_takeaway":"The SCARE score can help prioritize advanced prehospital resources for chest pain callers, but its NPV of 95% at the high-risk threshold means it should **not** be used as a stand-alone rule-out tool. Clinicians in non-physician dispatch systems should await prospective validation before adopting it."}},{"doi":"10.1016/j.ajem.2026.05.006","pmid":"42114386","title":"The prevalence of life-threatening diagnoses in emergency department patients with chest pain in a national group","journal_title":"The American Journal of Emergency Medicine","journal_issn":"0735-6757","published_at":"2026-05-12T00:00:00.000Z","url":"https://doi.org/10.1016/j.ajem.2026.05.006","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-08","doi":"10.1016/j.ajem.2026.05.006","days":"7","issn":"0735-6757","rank":"5","field":"Clinical Medicine","score":"2","category":"Emergency Medicine","categories":["Emergency Medicine"],"_categories":["Emergency Medicine"]},"pubmed":{"doi":"10.1016/j.ajem.2026.05.006","title":"The prevalence of life-threatening diagnoses in emergency department patients with chest pain in a national group.","journal":"The American journal of emergency medicine","methods":"","results":"In 13,744,869 ED encounters, 951,152 (6.9%) had a complaint of atraumatic chest pain with 52,410 (5.5%) of these diagnosed with a life-threatening condition in the ED. ACS was most common (4.5%), followed by PE (0.78%), pneumothorax (0.13%), TAD (0.09%), esophageal rupture (0.007%), pericardial tamponade (0.005%), and ruptured aortic aneurysm (0.002%). The prevalence of life-threatening diagnoses was higher in patients who were older, male, covered by commercial insurance, who had higher-acuity triage emergency severity index (ESI) levels, arrived by ambulance, and were seen in western U.S. EDs.","abstract":"$30","keywords":["ACS","Chest pain","Dissection","Emergency","Life-threatening","Pulmonary embolism"],"pubmed_id":"42114386","conclusions":"Approximately 1 in 18 ED patients with atraumatic chest pain presents with a life-threatening condition. ACS is the most common followed by PE, pneumothorax and TAD. Other diagnoses are very rare. These data may serve as a priori pre-test probabilities for ED clinicians in the evaluation of chest pain.","publication_date":"2026-05-12T00:00:00"},"crossref":{"DOI":"10.1016/j.ajem.2026.05.006","URL":"https://doi.org/10.1016/j.ajem.2026.05.006","ISSN":["0735-6757"],"link":[{"URL":"https://api.elsevier.com/content/article/PII:S0735675726002123?httpAccept=text/xml","content-type":"text/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://api.elsevier.com/content/article/PII:S0735675726002123?httpAccept=text/plain","content-type":"text/plain","content-version":"vor","intended-application":"text-mining"}],"page":"96-101","type":"journal-article","issue":null,"score":1,"title":["The prevalence of life-threatening diagnoses in emergency department patients with chest pain in a national group"],"author":[{"given":"Daniel R.","family":"Rice","sequence":"first","affiliation":[]},{"given":"Michael J.","family":"Pallaci","sequence":"additional","affiliation":[]},{"given":"Michael B.","family":"Weinstock","sequence":"additional","affiliation":[]},{"given":"Samuel S.","family":"Cray","sequence":"additional","affiliation":[]},{"given":"Krista M.","family":"Foster","sequence":"additional","affiliation":[]},{"given":"Jonathan J.","family":"Oskvarek","sequence":"additional","affiliation":[]},{"given":"John J.","family":"Bedolla","sequence":"additional","affiliation":[]},{"given":"Amer Z.","family":"Aldeen","sequence":"additional","affiliation":[]},{"given":"Jesse M.","family":"Pines","sequence":"additional","affiliation":[]}],"issued":{"date-parts":[[2026,8]]},"member":"78","prefix":"10.1016","source":"Crossref","volume":"106","created":{"date-time":"2026-05-05T07:07:49Z","timestamp":1777964869000,"date-parts":[[2026,5,5]]},"indexed":{"date-time":"2026-05-11T23:21:28Z","timestamp":1778541688753,"date-parts":[[2026,5,11]]},"license":[{"URL":"https://www.elsevier.com/tdm/userlicense/1.0/","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"https://www.elsevier.com/legal/tdmrep-license","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"https://doi.org/10.15223/policy-017","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"stm-asf"},{"URL":"https://doi.org/10.15223/policy-037","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"stm-asf"},{"URL":"https://doi.org/10.15223/policy-012","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"stm-asf"},{"URL":"https://doi.org/10.15223/policy-029","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"stm-asf"},{"URL":"https://doi.org/10.15223/policy-004","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"stm-asf"}],"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"https://linkinghub.elsevier.com/retrieve/pii/S0735675726002123"}},"subtitle":[],"assertion":[{"name":"publisher","label":"This article is maintained by","value":"Elsevier"},{"name":"articletitle","label":"Article Title","value":"The prevalence of life-threatening diagnoses in emergency department patients with chest pain in a national group"},{"name":"journaltitle","label":"Journal Title","value":"The American Journal of Emergency Medicine"},{"name":"articlelink","label":"CrossRef DOI link to publisher maintained version","value":"https://doi.org/10.1016/j.ajem.2026.05.006"},{"name":"content_type","label":"Content Type","value":"article"},{"name":"copyright","label":"Copyright","value":"© 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies."}],"deposited":{"date-time":"2026-05-11T22:57:05Z","timestamp":1778540225000,"date-parts":[[2026,5,11]]},"issn-type":[{"type":"print","value":"0735-6757"}],"published":{"date-parts":[[2026,8]]},"publisher":"Elsevier BV","reference":[{"DOI":null,"key":"10.1016/j.ajem.2026.05.006_bb0005","year":"2024","issue":null,"author":"Cairns","volume":"503","first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":null},{"DOI":"10.1007/s10140-018-1587-x","key":"10.1016/j.ajem.2026.05.006_bb0010","year":"2018","issue":"3","author":"Ohle","volume":"25","first-page":"293","unstructured":null,"article-title":"Variation in emergency department use of computed tomography for investigation of acute aortic dissection","journal-title":"Emerg Radiol","doi-asserted-by":"crossref"},{"DOI":"10.1017/cem.2019.1","key":"10.1016/j.ajem.2026.05.006_bb0015","year":"2019","issue":"5","author":"Ohle","volume":"21","first-page":"618","unstructured":null,"article-title":"A simple intervention to reduce your chance of missing an acute aortic dissection","journal-title":"CJEM","doi-asserted-by":"crossref"},{"DOI":"10.1016/j.ajem.2021.11.047","key":"10.1016/j.ajem.2026.05.006_bb0020","year":"2022","issue":null,"author":"Lovatt","volume":"53","first-page":"16","unstructured":null,"article-title":"Misdiagnosis of aortic dissection: a systematic review of the literature","journal-title":"Am J Emerg Med","doi-asserted-by":"crossref"},{"DOI":"10.1001/jamainternmed.2021.0269","key":"10.1016/j.ajem.2026.05.006_bb0025","year":"2021","issue":"6","author":"Morgan","volume":"181","first-page":"747","unstructured":null,"article-title":"Accuracy of practitioner estimates of probability of diagnosis before and after testing","journal-title":"JAMA Intern Med","doi-asserted-by":"crossref"},{"DOI":"10.1001/jama.2015.12735","key":"10.1016/j.ajem.2026.05.006_bb0030","year":"2015","issue":"18","author":"Fanaroff","volume":"314","first-page":"1955","unstructured":null,"article-title":"Does this patient with chest pain have acute coronary syndrome?: the rational clinical examination systematic review","journal-title":"JAMA","doi-asserted-by":"crossref"},{"DOI":"10.1097/MEJ.0000000000000680","key":"10.1016/j.ajem.2026.05.006_bb0035","year":"2020","issue":"5","author":"Lefevre-Scelles","volume":"27","first-page":"357","unstructured":null,"article-title":"Investigation of pulmonary embolism in patients with chest pain in the emergency department: a retrospective multicenter study","journal-title":"Eur J Emerg Med","doi-asserted-by":"crossref"},{"DOI":"10.5811/westjem.2015.6.25752","key":"10.1016/j.ajem.2026.05.006_bb0040","year":"2015","issue":"5","author":"Alter","volume":"16","first-page":"629","unstructured":null,"article-title":"Diagnosis of aortic dissection in emergency department patients is rare","journal-title":"West J Emerg Med","doi-asserted-by":"crossref"},{"DOI":"10.1016/j.jflm.2017.04.003","key":"10.1016/j.ajem.2026.05.006_bb0045","year":"2017","issue":null,"author":"Wu","volume":"48","first-page":"41","unstructured":null,"article-title":"Learning from an analysis of closed malpractice litigation involving myocardial infarction","journal-title":"J Forensic Leg Med","doi-asserted-by":"crossref"},{"DOI":"10.1111/j.1553-2712.2010.00729.x","key":"10.1016/j.ajem.2026.05.006_bb0050","year":"2010","issue":"5","author":"Brown","volume":"17","first-page":"553","unstructured":null,"article-title":"An epidemiologic study of closed emergency department malpractice claims in a national database of physician malpractice insurers","journal-title":"Acad Emerg Med","doi-asserted-by":"crossref"},{"DOI":"10.1016/j.annemergmed.2017.11.011","key":"10.1016/j.ajem.2026.05.006_bb0055","year":"2018","issue":"5","author":"Pines","volume":"71","first-page":"545","unstructured":null,"article-title":"Measurement under the microscope: high variability and limited construct validity in emergency department patient-experience scores","journal-title":"Ann Emerg Med","doi-asserted-by":"crossref"},{"DOI":"10.1016/j.annemergmed.2017.06.023","key":"10.1016/j.ajem.2026.05.006_bb0060","year":"2018","issue":"2","author":"Carlson","volume":"71","first-page":"157","unstructured":null,"article-title":"Provider and practice factors associated with emergency physicians’ being named in a malpractice claim","journal-title":"Ann Emerg Med","doi-asserted-by":"crossref"},{"DOI":"10.1001/jamainternmed.2016.2498","key":"10.1016/j.ajem.2026.05.006_bb0065","year":"2016","issue":"7","author":"Hsia","volume":"176","first-page":"1029","unstructured":null,"article-title":"A national study of the prevalence of life-threatening diagnoses in patients with chest pain","journal-title":"JAMA Intern Med","doi-asserted-by":"crossref"},{"DOI":"10.1016/j.jvs.2018.03.435","key":"10.1016/j.ajem.2026.05.006_bb0070","year":"2019","issue":"2","author":"Abdulameer","volume":"69","first-page":"378","unstructured":null,"article-title":"Epidemiology of fatal ruptured aortic aneurysms in the United States (1999-2016)","journal-title":"J Vasc Surg","doi-asserted-by":"crossref"},{"DOI":null,"key":"10.1016/j.ajem.2026.05.006_bb0075","year":"2000","issue":"2","author":"Bertakis","volume":"49","first-page":"147","unstructured":null,"article-title":"Gender differences in the utilization of health care services","journal-title":"J Fam Pract","doi-asserted-by":null},{"DOI":"10.1136/bmjopen-2021-054622","key":"10.1016/j.ajem.2026.05.006_bb0080","year":"2022","issue":"8","author":"Wibring","volume":"12","first-page":null,"unstructured":null,"article-title":"Clinical presentation in EMS patients with acute chest pain in relation to sex, age and medical history: prospective cohort study","journal-title":"BMJ Open","doi-asserted-by":"crossref"},{"DOI":"10.1186/s12913-015-1119-2","key":"10.1016/j.ajem.2026.05.006_bb0085","year":"2015","issue":null,"author":"van Loenen","volume":"15","first-page":"465","unstructured":null,"article-title":"Propensity to seek healthcare in different healthcare systems: analysis of patient data in 34 countries","journal-title":"BMC Health Serv Res","doi-asserted-by":"crossref"},{"DOI":"10.1161/CIR.0000000000001089","key":"10.1016/j.ajem.2026.05.006_bb0090","year":"2022","issue":"12","author":"Jurgens","volume":"146","first-page":"e173","unstructured":null,"article-title":"State of the science: the relevance of symptoms in cardiovascular disease and research: a scientific statement from the American Heart Association","journal-title":"Circulation","doi-asserted-by":"crossref"},{"DOI":"10.1001/jamanetworkopen.2023.3404","key":"10.1016/j.ajem.2026.05.006_bb0095","year":"2023","issue":"3","author":"Sax","volume":"6","first-page":null,"unstructured":null,"article-title":"Evaluation of the emergency severity index in US emergency departments for the rate of mistriage","journal-title":"JAMA Netw Open","doi-asserted-by":"crossref"},{"DOI":"10.1001/jamanetworkopen.2025.8498","key":"10.1016/j.ajem.2026.05.006_bb0100","year":"2025","issue":"5","author":"Sax","volume":"8","first-page":null,"unstructured":null,"article-title":"Emergency department triage accuracy and delays in care for high-risk conditions","journal-title":"JAMA Netw Open","doi-asserted-by":"crossref"},{"DOI":null,"key":"10.1016/j.ajem.2026.05.006_bb0105","year":"2025","issue":"13","author":"Rao","volume":"151","first-page":"e771","unstructured":null,"article-title":"2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines","journal-title":"Circulation","doi-asserted-by":null},{"DOI":"10.1111/j.1553-2712.2011.01005.x","key":"10.1016/j.ajem.2026.05.006_bb0110","year":"2011","issue":"3","author":"Hiestand","volume":"18","first-page":"261","unstructured":null,"article-title":"The influence of emergency medical services transport on emergency severity index triage level for patients with abdominal pain","journal-title":"Acad Emerg Med","doi-asserted-by":"crossref"},{"DOI":"10.1016/j.amepre.2021.03.026","key":"10.1016/j.ajem.2026.05.006_bb0115","year":"2021","issue":"4","author":"Al Rifai","volume":"61","first-page":"492","unstructured":null,"article-title":"Prevalence and determinants of difficulty in accessing medical care in U.S. adults","journal-title":"Am J Prev Med","doi-asserted-by":"crossref"},{"DOI":"10.15585/mmwr.mm7013a1","key":"10.1016/j.ajem.2026.05.006_bb0120","year":"2021","issue":"13","author":"Song","volume":"70","first-page":"461","unstructured":null,"article-title":"Use of selected recommended clinical preventive services - behavioral risk factor surveillance system, United States, 2018","journal-title":"MMWR Morb Mortal Wkly Rep","doi-asserted-by":"crossref"},{"DOI":"10.1016/S0196-0644(97)70221-X","key":"10.1016/j.ajem.2026.05.006_bb0125","year":"1997","issue":"4","author":"Rucker","volume":"29","first-page":"484","unstructured":null,"article-title":"Patient-specific predictors of ambulance use","journal-title":"Ann Emerg Med","doi-asserted-by":"crossref"}],"short-title":[],"update-policy":"https://doi.org/10.1016/elsevier_cm_policy","alternative-id":["S0735675726002123"],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"original-title":[],"container-title":["The American Journal of Emergency Medicine"],"published-print":{"date-parts":[[2026,8]]},"reference-count":25,"published-online":null,"references-count":25,"special_numbering":"C","short-container-title":["The American Journal of Emergency Medicine"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1016/j.ajem.2026.05.006","is_oa":false,"title":"The prevalence of life-threatening diagnoses in emergency department patients with chest pain in a national group","updated":"2026-05-12T08:54:10+00:00","published_date":"2026-05-05","best_oa_location":null}},"created_at":"2026-05-12T13:18:11.960Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"condition","value":"Acute Coronary Syndrome","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"condition","value":"Chest Pain","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"condition","value":"Esophageal Rupture","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"condition","value":"Pericardial Tamponade","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"condition","value":"Pneumothorax","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"condition","value":"Pulmonary Embolism","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"condition","value":"Ruptured Aortic Aneurysm","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"condition","value":"Thoracic Aortic Dissection","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"sample_size","value":"n=951152","value_numeric":951152},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"warning","value":"Diagnoses are based on administrative/ICD coding from a single ED staffing group (USACS); coding errors or selection bias may affect reported prevalence rates.","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"warning","value":"The study does not capture diagnoses made after ED discharge, so true prevalence of life-threatening conditions may be slightly underestimated.","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"warning","value":"The total encounter pool (13.7 million) reflects all ED visits; the chest pain cohort (951,152) is the relevant denominator for prevalence figures — clinicians should use the latter when applying these numbers as pre-test probabilities.","value_numeric":null}],"summaries":{"what_studied":"Prevalence of seven life-threatening diagnoses (ACS, PE, pneumothorax, TAD, esophageal rupture, pericardial tamponade, ruptured aortic aneurysm) among ED patients presenting with atraumatic chest pain across 141 U.S. EDs in 17 states from January 2021 to December 2024.","key_result":"Of 951,152 atraumatic chest pain visits, 5.5% (~1 in 18) had a life-threatening diagnosis. ACS was most common (4.5%), followed by PE (0.78%), pneumothorax (0.13%), TAD (0.09%), esophageal rupture (0.007%), pericardial tamponade (0.005%), and ruptured aortic aneurysm (0.002%). Higher prevalence was seen in older, male, commercially insured patients with higher-acuity triage levels who arrived by ambulance.","limitations":"- Retrospective, observational design using administrative/billing data — diagnosis accuracy depends on coding quality.\n- Single ED group (USACS) staffing 141 sites, which may limit generalizability to other U.S. health systems or regions.\n- No follow-up beyond the ED visit; missed diagnoses discharged home would not be captured.","practice_takeaway":"Clinicians can use these large-scale prevalence figures as pre-test probabilities when evaluating chest pain: roughly 1 in 22 patients has ACS, and TAD/esophageal rupture/tamponade are each far rarer than 1 in 1,000. Higher acuity triage, ambulance arrival, older age, and male sex should raise suspicion for life-threatening etiologies."}},{"doi":"10.1080/10903127.2026.2661802","pmid":"42029007","title":"Emergency Medical Services Responses at a Large Immigration Detention Facility in Rural Georgia: A Descriptive Analysis","journal_title":"Prehospital Emergency Care","journal_issn":"1090-3127","published_at":"2026-05-08T00:00:00.000Z","url":"https://doi.org/10.1080/10903127.2026.2661802","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-04T13:23:41.560Z","updated_at":"2026-06-04T13:23:41.560Z","tags":[{"paper_doi":"10.1080/10903127.2026.2661802","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2661802","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2661802","tag_type":"condition","value":"Abdominal Pain","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2661802","tag_type":"condition","value":"Chest Pain","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2661802","tag_type":"condition","value":"Dyspnea","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2661802","tag_type":"condition","value":"Medical Emergencies in Detention","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2661802","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2661802","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2661802","tag_type":"sample_size","value":"n=345","value_numeric":345},{"paper_doi":"10.1080/10903127.2026.2661802","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2661802","tag_type":"study_design","value":"Cross-Sectional Study","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2661802","tag_type":"warning","value":"No drug or therapeutic intervention is described; modality, brand, and generic tags are not applicable to this study.","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2661802","tag_type":"warning","value":"Population is 98% male, limiting sex-based generalizability. The 'mixed' sex tag reflects the nominal inclusion of 6 female encounters.","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2661802","tag_type":"warning","value":"Study predates the post-2025 surge in ICE detention populations; current operational impact may be substantially higher.","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2661802","tag_type":"warning","value":"The 13% figure for EMS responses (544 of 4,148) includes all SDC activations, while the 345 transport figure covers only transported encounters — these counts reflect different denominators.","value_numeric":null}],"summaries":{"what_studied":"Cross-sectional analysis of EMS activations requiring transport from Stewart Detention Center (SDC), a large rural ICE facility in Georgia, from April 2018 to August 2021, examining patient demographics, chief complaints, vital sign acuity, and transport disposition.","key_result":"345 EMS transports occurred over ~3.5 years; SDC accounted for 13% (544/4,148) of all local EMS responses. Top complaints were chest pain (24%), abdominal pain (12%), and breathing problems (9%). 38% had ≥1 abnormal vital sign; 43% required transfer to a tertiary hospital ~40 miles away. EMS-reported transports represented only 33% of ICE-reported medical emergencies.","limitations":"- Single-facility, nearly all-male population run by one private contractor in rural Georgia, limiting generalizability to other ICE settings.\n- Data ends in 2021, during ongoing COVID-19 disruptions; patterns may have shifted with the post-2025 detention expansion.\n- ALS vs. BLS designation per encounter was unavailable, and transport guidelines used by EMS were not accessible.","practice_takeaway":"EMS agencies serving rural ICE detention facilities should anticipate a disproportionate share of high-acuity calls requiring long-distance tertiary transfer, which can deplete limited ambulance resources for the broader community. As detention populations expand, EMS systems in similar rural jurisdictions should proactively plan staffing, mutual aid, and transport protocols."}},{"doi":"10.7326/annals-25-02772","pmid":"41996184","title":"Rapid Evaluation of Artificial Intelligence Technology Used for Ambient Dictation in Primary Care: Comparing the Quality of Documentation of Artificial Intelligence–Generated and Human-Produced Clinical Notes","journal_title":"Annals of Internal Medicine","journal_issn":"0003-4819","published_at":"2026-04-17T00:00:00.000Z","url":"https://doi.org/10.7326/annals-25-02772","source_score":326,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-21T13:29:57.454Z","updated_at":"2026-06-21T13:29:57.454Z","tags":[{"paper_doi":"10.7326/annals-25-02772","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.7326/annals-25-02772","tag_type":"category","value":"Medicine, General & Internal","value_numeric":null},{"paper_doi":"10.7326/annals-25-02772","tag_type":"condition","value":"Acute Low Back Pain","value_numeric":null},{"paper_doi":"10.7326/annals-25-02772","tag_type":"condition","value":"Chest Pain","value_numeric":null},{"paper_doi":"10.7326/annals-25-02772","tag_type":"condition","value":"Primary Care Documentation","value_numeric":null},{"paper_doi":"10.7326/annals-25-02772","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.7326/annals-25-02772","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.7326/annals-25-02772","tag_type":"modality","value":"Ambient AI Scribe","value_numeric":null},{"paper_doi":"10.7326/annals-25-02772","tag_type":"sample_size","value":"n=59","value_numeric":59},{"paper_doi":"10.7326/annals-25-02772","tag_type":"study_design","value":"Cross-Sectional Study","value_numeric":null},{"paper_doi":"10.7326/annals-25-02772","tag_type":"warning","value":"Specific AI scribe vendor names are not disclosed in the abstract; findings reflect a vendor-neutral aggregate and may not apply to any single product.","value_numeric":null},{"paper_doi":"10.7326/annals-25-02772","tag_type":"warning","value":"Study used simulated standardized patient encounters rather than real clinical visits, which may limit generalizability to everyday practice.","value_numeric":null},{"paper_doi":"10.7326/annals-25-02772","tag_type":"warning","value":"The sample_size tag reflects total participants across all roles (11 AI tools + 18 human note takers + 30 raters = 59); these are not patients, so interpret with caution.","value_numeric":null}],"summaries":{"what_studied":"A cross-sectional study at the Veterans Health Administration compared documentation quality of notes from 11 ambient AI scribe tools versus 18 human clinicians across 5 standardized primary care cases, scored by 30 blinded raters using the modified PDQI-9 instrument (max score 50).","key_result":"Human-generated notes scored higher than AI notes in all 5 cases. The gap was largest in acute low back pain (human: 43.8 vs. AI: 20.3; difference −23.5 [95% CI, −29.2 to −17.9]). AI notes fell short across all 10 quality domains, with the biggest deficits in thoroughness (−1.23), organization (−1.06), and usefulness (−1.03).","limitations":"- Cases used standardized (simulated) patients, not real clinical encounters.\n- Human note takers worked without real-world time pressures, which may have inflated their scores.\n- Findings reflect AI tools available at time of evaluation; tool performance evolves rapidly.","practice_takeaway":"Before deploying ambient AI scribes at scale, clinics should require independent, vendor-neutral quality evaluations — particularly for complex visit types like musculoskeletal complaints where AI note quality lagged furthest behind. Physician oversight and editing of AI-generated notes remains essential."}},{"doi":"10.1111/1742-6723.70210","pmid":"41502245","title":"Identifying Predictor Variables for a Future Clinical Decision Rule for Ordering of Chest X‐Rays (\n CXR\n ) for Non‐Traumatic Chest Pain in Adult Emergency Department (\n ED\n ) Patients","journal_title":"Emergency Medicine Australasia","journal_issn":"1742-6731","published_at":"2026-01-08T00:00:00.000Z","url":"https://doi.org/10.1111/1742-6723.70210","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-01-10","doi":"10.1111/1742-6723.70210","days":"7","issn":"1742-6731","rank":"8","field":"Clinical Medicine","score":"2","category":"Emergency Medicine","categories":["Emergency Medicine"],"_categories":["Emergency Medicine"]},"pubmed":{"doi":"10.1111/1742-6723.70210","title":"Identifying Predictor Variables for a Future Clinical Decision Rule for Ordering of Chest X-Rays (CXR) for Non-Traumatic Chest Pain in Adult Emergency Department (ED) Patients.","journal":"Emergency medicine Australasia : EMA","methods":"","results":"Of the 40 candidate variables, 10 were most agreed upon; however, only three had perfect inter-rater agreement and reliability.","abstract":"We sought to identify predictor variables for a future clinical decision rule for CXR ordering in non-traumatic chest pain.\nEmergency Medicine Physicians were asked to select variables that would result in a CXR being ordered. Inter-rater reliability (using Fleiss' kappa) was calculated for the most commonly agreed upon.\nOf the 40 candidate variables, 10 were most agreed upon; however, only three had perfect inter-rater agreement and reliability.\nIn this study, only an abnormal lung examination, a suspicion of pneumonia or of acute pulmonary oedema had perfect inter-rater agreement and reliability. Further research is required on a larger scale to refine and identify the optimal candidate variables for inclusion in a clinical decision rule.","keywords":[],"pubmed_id":"41502245","conclusions":"","publication_date":"2026-01-08T00:00:00"},"crossref":{"DOI":"10.1111/1742-6723.70210","URL":"https://doi.org/10.1111/1742-6723.70210","ISSN":["1742-6731","1742-6723"],"link":[{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/1742-6723.70210","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":"1","score":1,"title":["Identifying Predictor Variables for a Future Clinical Decision Rule for Ordering of Chest X‐Rays (\n CXR\n ) for Non‐Traumatic Chest Pain in Adult Emergency Department (\n ED\n ) Patients"],"author":[{"given":"Joe Anthony","family":"Rotella","sequence":"first","affiliation":[{"name":"Cardiac Emergency Victorian Heart Hospital Clayton Victoria Australia"},{"name":"Department of Critical Care Melbourne Medical School Parkville Victoria Australia"}]}],"issued":{"date-parts":[[2026,1,7]]},"member":"311","prefix":"10.1111","source":"Crossref","volume":"38","archive":["Portico"],"created":{"date-time":"2026-01-08T07:55:32Z","timestamp":1767858932000,"date-parts":[[2026,1,8]]},"indexed":{"date-time":"2026-01-08T11:38:22Z","timestamp":1767872302119,"date-parts":[[2026,1,8]]},"license":[{"URL":"http://onlinelibrary.wiley.com/termsAndConditions#vor","start":{"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000,"date-parts":[[2026,1,7]]},"delay-in-days":0,"content-version":"vor"}],"subject":[],"abstract":"$31","language":"en","relation":{},"resource":{"primary":{"URL":"https://onlinelibrary.wiley.com/doi/10.1111/1742-6723.70210"}},"subtitle":[],"assertion":[{"name":"received","group":{"name":"publication_history","label":"Publication History"},"label":"Received","order":0,"value":"2025-09-10"},{"name":"accepted","group":{"name":"publication_history","label":"Publication History"},"label":"Accepted","order":2,"value":"2025-12-23"},{"name":"published","group":{"name":"publication_history","label":"Publication History"},"label":"Published","order":3,"value":"2026-01-07"}],"deposited":{"date-time":"2026-01-08T07:55:33Z","timestamp":1767858933000,"date-parts":[[2026,1,8]]},"issn-type":[{"type":"print","value":"1742-6731"},{"type":"electronic","value":"1742-6723"}],"published":{"date-parts":[[2026,1,7]]},"publisher":"Wiley","reference":[{"DOI":"10.5694/mja16.00368","key":"e_1_2_10_2_1","year":"2016","issue":"3","author":"Chew D. P.","volume":"205","first-page":"128","unstructured":null,"article-title":"National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Management of Acute Coronary Syndromes 2016","journal-title":"Medical Journal of Australia","doi-asserted-by":"crossref"},{"DOI":"10.1017/S148180350001215X","key":"e_1_2_10_3_1","year":"2010","issue":"2","author":"Hess E. P.","volume":"12","first-page":"128","unstructured":null,"article-title":"Derivation of a Clinical Decision Rule for Chest Radiography in Emergency Department Patients With Chest Pain and Possible Acute Coronary Syndrome","journal-title":"Canadian Journal of Emergency Medicine","doi-asserted-by":"crossref"},{"DOI":"10.1016/S0736-4679(02)00499-7","key":"e_1_2_10_4_1","year":"2002","issue":"2","author":"Rothrock S. G.","volume":"23","first-page":"117","unstructured":null,"article-title":"High Yield Criteria for Obtaining Non‐Trauma Chest Radiography in the Adult Emergency Department Population","journal-title":"Journal of Emergency Medicine","doi-asserted-by":"crossref"},{"DOI":"10.1016/S0196-0644(99)70309-4","key":"e_1_2_10_5_1","year":"1999","issue":"4","author":"Stiell I. G.","volume":"33","first-page":"437","unstructured":null,"article-title":"Methodologic Standards for the Development of Clinical Decision Rules in Emergency Medicine","journal-title":"Annals of Emergency Medicine","doi-asserted-by":"crossref"},{"DOI":null,"key":"e_1_2_10_6_1","year":"2025","issue":null,"author":"DATAtabTeam","volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":null}],"short-title":[],"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,2]]}},"update-policy":"https://doi.org/10.1002/crossmark_policy","alternative-id":["10.1111/1742-6723.70210"],"article-number":"e70210","content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"original-title":[],"container-title":["Emergency Medicine Australasia"],"published-print":{"date-parts":[[2026,2]]},"reference-count":5,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,1,7]]},"references-count":5,"short-container-title":["Emerg Medicine Australasia"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1111/1742-6723.70210","is_oa":false,"title":"Identifying Predictor Variables for a Future Clinical Decision Rule for Ordering of Chest X‐Rays (\n CXR\n ) for Non‐Traumatic Chest Pain in Adult Emergency Department (\n ED\n ) Patients","updated":"2026-01-10T04:46:20+00:00","published_date":"2026-01-07","best_oa_location":null}},"created_at":"2026-01-14T18:30:49.575Z","updated_at":"2026-01-17T09:03:27.421Z","tags":[{"paper_doi":"10.1111/1742-6723.70210","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70210","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70210","tag_type":"condition","value":"Chest Pain","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70210","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70210","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70210","tag_type":"modality","value":"Chest X-Ray","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70210","tag_type":"study_design","value":"Cross-Sectional","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70210","tag_type":"warning","value":"Sample size and setting are not reported in the abstract.","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70210","tag_type":"warning","value":"Study design is inferred from a clinician survey; a Delphi or consensus method is possible.","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70210","tag_type":"warning","value":"The abstract states “perfect inter‑rater agreement” without providing kappa values or thresholds.","value_numeric":null}],"summaries":{"what_studied":"Emergency physicians were surveyed on which variables would prompt ordering a chest X‑ray for adult ED patients with non‑traumatic chest pain; Fleiss’ kappa measured inter‑rater reliability for the most commonly selected variables.","key_result":"Among 40 candidate variables, 10 were most commonly selected, but only three achieved perfect inter‑rater agreement: abnormal lung examination, suspected pneumonia, and suspected acute pulmonary oedema.","limitations":"Limited scale (authors call for larger studies) and focus on clinician agreement rather than diagnostic accuracy or patient outcomes.","practice_takeaway":"For adult, non‑traumatic chest pain in the ED, clinicians most consistently agree to order a CXR when the lung exam is abnormal or when pneumonia or acute pulmonary oedema is suspected; treat this as preliminary guidance pending validation."}}],"initialOffset":6,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Chest Pain"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Chest Pain"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Chest Pain"}}}]]

Papers