Tool to Determine Suitability for Discharging Chest Pain Patients

From ACEP:

Washington, DC—Canadian researchers have developed the "Vancouver Chest Pain Rule," which can be used to identify and safely discharge emergency patients with chest pain from the emergency department, following evaluation.

According to the study authors, this finding is important to relieving emergency department crowding and will improve the cost-effectiveness for certain coronary diagnostic tests, as well as reduce patient inconvenience. This study is included as an early online release from Annals of Emergency Medicine (A Clinical Prediction Rule for Early Discharge of Patients with Chest Pain).

"Patients who go to the emergency department with chest pain fall into three categories," explains lead study author James M. Christenson, MD, FRCPC, clinical professor, department of surgery, University of British Columbia and research director, St. Paul’s Hospital Department of Emergency Medicine. "There are those who have serious symptoms and need admission and treatment, those whose pain is not related to heart problems, and those who require testing and diagnosis to rule out acute or life-threatening conditions."

According to the findings, patients with normal cardiograms and negative blood tests (used to diagnose heart attacks) are considered at low risk for serious heart conditions and can be safely discharged without prolonged emergency department observation, expensive rule-out protocols or testing.

The Vancouver Chest Pain Rule uses age, medical history, diagnostic tests for heart disease, and pain characteristics to identify patients with chest pain but who do not have an acute heart condition. About one-third of patients screened this way are found, with minimal error, to be at very low-risk of heart problems. The Vancouver Rule reduced the number of patients who had undetected acute cardiac conditions and were discharged from 5 percent to only 1 percent in Canada.