A descriptive analysis of patients with an emergency department diagnosis of acute pericarditis
- 1Department of Emergency Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- 2Department of Emergency Medicine and Medical Education, University of Western Australia, Nedlands, Western Australia, Australia
- Correspondence to Winthrop Professor Antonio Celenza, Discipline of Emergency Medicine, Level 2, R Block, QE II Medical Centre, Hospital Avenue, Nedlands 6009, WA, Australia;
- Accepted 25 October 2012
- Published Online First 6 December 2012
Aim To describe clinical characteristics, assessment and treatment of patients diagnosed in an emergency department (ED) with acute pericarditis.
Methods A medical record review of patients with an ED diagnosis of pericarditis conducted in an adult tertiary hospital over a 5-year period. Variables collected included pain characteristics, associated symptoms, physical examination findings, investigation results, ED treatment and disposition.
Results 179 presentations were included, with 73.9% men and a mean age of 38.8 years. The majority of patients described pleuritic chest pain worse with inspiration with half characterising the pain as sharp or stabbing, with others describing tightness, dullness or cramping. Radiation to the left shoulder occurred in 2.8% and change of pain with posture occurred in 46.4%. A pericardial rub was documented in 19 presentations. All patients had an ECG recorded with ST segment elevation present in 69.3% and PR segment depression in 49.2%. Nearly 90% of patients had troponin testing but only 6.4% of these were positive. Only 8.1% of cases were treated with colchicine. No patients required pericardiocentesis. Patients with high-risk factors were more likely to have previous pericarditis, dyspnoea, nausea, abnormal investigation results, treatment with colchicine and admission to hospital. However, 16.9% of patients without risk factors were admitted, and 46.9% of patients with at least one risk factor were discharged.
Conclusions Pericarditis may not follow the classical clinical description. Admission and discharge decisions appear to relate to individual clinical characteristics rather than known risk factors. Use of colchicine for treatment in ED is infrequent.