Does the location of a primary pain complaint during transport by emergency medical services predict hospitalization status, length of stay, and mortality among patients with heart failure?

Abstract

Purpose: The purpose was to examine which locations of pain (abdominal, back, chest, or generalized) predict hospitalization status, length of stay, and mortality among patients with heart failure (HF) transported by emergency medical services (EMS) to the emergency department (ED). Research Question: Does presenting to EMS with a primary complaint of abdominal, back, chest, or generalized pain predict 1) higher hospital admission rates 2) longer length of stay, or 3) higher mortality rates compared to patients presenting with other primary complaints? Rationale: About 22% of patients with HF are transported by EMS to the ED with a primary complaint of pain. Locations of pain vary among patients with HF, but whether different locations of pain can differentiate health outcomes are unknown. Methods: A retrospective comparative descriptive study was conducted using electronic health records from EMS and hospitals. A total of 2,592 patients with HF transported between 2009-2017 were included in the analysis. Pain complaints included abdominal, back, chest, and generalized. Outcomes were hospitalization status, in-hospital mortality, and inpatient length of stay. Binomial logistic and linear regressions were used to answer research questions. Results: Demographics were mean age 66.15 (SD=14.93); gender 59.7% women, 54.6% men; race 54.6% Black, 44.6% White, 0.8% Other. Of 2,592 patients, 581 (22.4%) presented with pain, 1,886 were hospitalized (72.8%), 127 died during hospitalization (4.9%), and median length of hospital stay was 4.63 days. Pain frequencies were: chest=404 (69.5%), abdominal=100 (17.2%), generalized=45 (7.7%), and back=32 (5.5%). Compared to patients without pain, no locations of pain were significantly associated with hospitalization. Surprisingly, patients with chest pain were less likely to die during hospitalization compared to patients without pain (OR=0.44, p=.024). Furthermore, patients with chest pain (β =-0.49, p<.001) and generalized pain (β =-0.57, p=.011) were associated with a shorter length of stay compared to patients without pain. Conclusion: No locations of pain predicted hospitalization status. Chest pain was associated with decreased odds of in-hospital mortality, and both chest and generalized pain were associated with a shorter length of stay. One explanation may be the higher illness severity among patients with other primary complaints. Prospective studies are needed to understand the impact chronic pain in HF.