Clinical Prediction Rule of Christenson et al for Early Discharge of a Chest Pain Patient from the Emergency Department (Vancouver Chest Pain Rule)

Age of the patient

Does the patient have a normal ECG or T-wave flattening only?

• a prior history of ischemic chest pain, myocardial infarction and/or angina?

• a history of taking nitroglycerin?

• a clear-cut history of effort-related angina?

Do you have any suspicion of pulmonary embolus, aortic dissection or other serious condition?

• radiate to arm, neck and/or jaw?

• increase with a deep breath?

• increase with palpation?

Initial CK-MB

Has there been a significant change in the ECG in the 2 hours since presentation?

Has the CK-MB increased during the first 2 hours since the presentation?

Has the serum troponin increased by 2 hours after presentation?