North American & Vancouver Chest Pain Rule
ACEP should support emergency physicians utilizing these prospectively derived risk-stratification tools for early disposition of patients from the emergency department, specifically to address the medical legal fallout from moving to a rational, but not “zero miss,” strategy - Ryan Patrick Radecki MD
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HWN Suggests
Vancouver Chest Pain Rule
Various scoring systems have been devised to identify chest pain patients who are at low risk and can be safely discharged from the emergency department with little follow-up testing... In contrast, the Vancouver Chest Pain Rule [Box], which was derived and validated, does not provide acute coronary syndrome risk estimates per se. Rather, it provides physicians with guidance on when to safely discharge patients without additional investigations (such as stress tests) or hospital admission. The main goal of the Vancouver Chest Pain Rule is to reduce admissions of low-risk patients. The rule is more than 99% sensitive and more than 20% specific for acute coronary syndrome.Featured
New Decision Instruments That Predict Risk of Thrombolysis in Myocardial Infarction May Make TIMI Score Obsolete
Most important, however, the development of these ED-centric decision instruments and disposition pathways, along with the North American Chest Pain Rule, indicate emergency medicine has moved beyond the hand-me-downs from our cardiology brethren. Not only is it time for TIMI to be retired, it’s likely time to reconsider the relevance of the other American Heart Association recommendations for the evaluation of acute nonspecific chest pain in the emergency department.
Articles of Interest
Validation of the North American Chest Pain Rule in Prediction of Very Low-Risk Chest Pain; a Diagnostic Accuracy Study
In summary, our study proved that the prediction rule proposed by Hess et al. is a sensitive decision tool for diagnosing very-low-risk chest pain patients who can be discharged early from the ED.
Resources
North American Chest Pain Rule (NACPR)
Hess et al reported the North American Chest Pain Rule (NACPR). This can help to identify a patient at low risk who can have an early discharge. The authors are from the Mayo Clinic.
