Diagnostic Agreement between Prehospital Emergency and In-Hospital Physicians

Table 3

Differential diagnosis of chest pain, adapted from Conaghy et al.

Acute myocardial infarction	Chest pain radiates to both arms	7.1	0.67
	Third heart sound on auscultation	3.2	0.88
	Hypotension	3.1	0.96
Chest wall pain	At least two of the following findings: localized muscle tension; stinging pain; pain reproducible by palpation; absence of cough	3.0	0.47
Gastroesophageal reflux disease	Burning retrosternal pain, acid regurgitation, sour or bitter taste in the mouth; one-week trial of high-dose proton pump inhibitors relieves symptoms	3.1	0.30
Panic disorder/anxiety state	Single question: in the past four weeks, have you had an anxiety attack (suddenly feeling fear or panic)?	4.2	0.09
Acute thoracic aortic dissection	Acute chest or back pain and a pulse differential in the upper extremities	5.3	NA

Note: The higher the LR is above 1, the better it rules in disease (greater than 10 is considered good). Conversely, the lower the LR is below 1, the better it rules out disease (less than 0.1 is considered good). LR+ = positive likelihood ration; LR- = negative likelihood ratio; NA = not available. Information is from references [5] through [6].