Scheuermeyer et al reported a prediction rule for early discharge of a patient with chest pain from the Emergency Department. The authors are from St Paul's Hospital, University of British Columbia, University of Calgary, Foothills Hospital and Vancouver Hospital in Vancouver, British Columbia.
Difference from previous rule: use of troponin instead of CK; different age cut-off
Patient selection: potentially ischemic chest pain in the Emergency Department
Initial criteria for no early discharge - any of the following:
(1) abnormal initial ECG
(2) positive serum troponin test at 2 hours (greater than 99th percentile, > 0.01 ng/mL)
(3) positive for history of acute coronary syndrome or nitrate use
Criteria for early discharge - one of the following:
(1) palpation reproduces pain
(2) palpation does not reproduce pain and both of the following:
(2a) age < 50 years of age
(2b) pain does not radiates to neck, jaw or left arm?
If the patient does not meet the criteria for early discharge then the patient continues in the ED.
