Multicultural presentation of chest pain at an emergency department in Australia

Paul M Middleton; Tammy Ll Wu; Riccardo Yih-Nan Lee; Shiquan Ren; Mary-Louise McLaws

doi:10.1111/1742-6723.13681

Multicultural presentation of chest pain at an emergency department in Australia

Emerg Med Australas. 2021 Jun;33(3):508-516. doi: 10.1111/1742-6723.13681. Epub 2020 Nov 24.

Authors

Paul M Middleton^{1

2

3

4

5}, Tammy Ll Wu^{1

2

3}, Riccardo Yih-Nan Lee^{1

2}, Shiquan Ren^{1

2

3}, Mary-Louise McLaws⁶

Affiliations

¹ South Western Emergency Research Institute, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.
² South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
³ Department of Emergency Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.
⁴ Discipline of Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia.
⁵ MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, New South Wales, Australia.
⁶ School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia.

PMID: 33236513
DOI: 10.1111/1742-6723.13681

Abstract

Objective: To investigate differences in presenting patient characteristics, investigation, management and related outcomes between culturally and linguistically diverse (CALD) and non-CALD chest pain (CP) patients presenting to the ED.

Methods: A cohort study of 258 patients was enrolled on presentation to Liverpool Hospital ED with a complaint of CP over a 2-week period. Main outcomes included frequency and timeliness of diagnostic and radiological investigations, medication administered and ED length of stay. Administrative and clinical data were extracted and linked from Cerner EMR FirstNet®, PowerChart® and paper records.

Results: There were 155 (60%) CALD and 103 (40%) non-CALD patients. CALD patients were older by 10 years (95% CI 4, 15; P < 0.0001). There were no significant differences in the number of pathology and imaging investigations carried out in each group, and similarly there were no significant differences in the number of patients administered analgesia or cardiac-specific medications. Neither group differed in their ED length of stay (median 280 vs 259.5 min; P = 0.79) or hospital admission rate (median 56% vs 55%, P = 0.8).

Conclusion: Both CALD and non-CALD ED CP patients had similar test ordering, medication administration and clinical outcomes, but this was in the context of CALD patients being 10 years older together with a small study sample size. A larger cohort, matched for age, would provide further insights into potentially important differences.

Keywords: chest pain; culturally and linguistically diverse; emergency medicine; epidemiology; ethnicity.