Screening for Panic Disorder in Individuals Presenting to the Emergency Department with Noncardiac Chest Pain: A Literature Review

Abstract

Introduction: Individuals with panic disorder (PD) often present to an emergency department (ED) with cardiopulmonary complaints. In the ED, life-threatening causes of chest pain are eliminated, but individuals are discharged without a diagnosis of PD. Left untreated, PD has significant consequences. A screening tool is a simple device that could be implemented to screen for PD in the ED. Objectives: To identify PD screening tools designed to be used in the ED and compare/contrast them on several dimensions. Methods: Two databases were used to conduct the literature search. The following search terms and synonyms were used: Screening, Panic Disorder, Emergency Department and Chest Pain. Of the 51 articles located, four were deemed suitable to include in this review, and five screening tools were evaluated. Results: All screening tools evaluated in this review are brief, taking five minutes or less to administer. The PSS and PHQ-PD are not sensitive (51.8% and 60.9%, respectively). The PDSQ-PD has the highest sensitivity (87.0%) but poor specificity (52.3%). The 7-ICRT has high sensitivity (81.7%) and specificity (87.9%). The PSS-R has fair sensitivity and specificity (70.9% and 75.2%, respectively). Conclusion: Both the 7-ICRT and the PSS-R could be used in the ED to improve upon current low rates of PD detection by physicians. By implementing a PD screening tool in the ED as a standard of care more individuals will be diagnosed with PD and hopefully receive follow-up with a primary care provider for treatment, thus improving outcomes for patients and the healthcare system.