A study to derive a clinical decision rule for triage of emergency department patients with chest pain: design and methodology

The goal of this study is to derive a clinical decision rule which will allow emergency physicians to accurately identify patients with chest pain who are safe for early discharge. The study will utilize a prospective cohort design. Standardized clinical variables will be collected on all patients at least 25 years of age complaining of chest pain prior to provocative testing. Variables strongly associated with the composite outcome acute myocardial infarction, revascularization, or death will be further analyzed with multivariable analysis to derive the clinical rule. Specific aims are to: i) apply standardized clinical assessments to patients with chest pain, incorporating results of early cardiac testing; ii) determine the inter-observer reliability of the clinical information; iii) determine the statistical association between the clinical findings and the composite outcome; and iv) use multivariable analysis to derive a highly sensitive clinical decision rule to guide triage decisions.The study will derive a highly sensitive clinical decision rule to identify low risk patients safe for early discharge. This will improve patient care, lower healthcare costs, and enhance flow in our busy and overcrowded emergency departments.Patients with acute chest pain often undergo extensive diagnostic testing and risk stratification to diagnose acute coronary syndrome (ACS) and determine the likelihood of future adverse cardiac events. Chest pain can be either cardiac or noncardiac in etiology and represents a continuum of risk from benign self-limiting conditions to life-threatening illness requiring rapid diagnosis and treatment. Currently it is not well established which patients require extensive diagnostic investigation. The goal of this study is to derive a clinical decision rule that predicts adverse cardiac events with a high degree of sensitivity and which will allow emergency physicians to accurately identify patients with chest pain who are safe for early discharg