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A comparative analysis of risk stratification tools for emergency department patients with chest pain


Burkett, E and Marwick, T and Thom, O and Kelly, AM, A comparative analysis of risk stratification tools for emergency department patients with chest pain, International Journal of Emergency Medicine, 7, (1) Article 10. ISSN 1865-1380 (2014) [Refereed Article]

Copyright Statement

Copyright 2009 Springer

DOI: doi:10.1186/1865-1380-7-10


BACKGROUND: Appropriate disposition of emergency department (ED) patients with chest pain is dependent on clinical evaluation of risk. A number of chest pain risk stratification tools have been proposed. The aim of this study was to compare the predictive performance for major adverse cardiac events (MACE) using risk assessment tools from the National Heart Foundation of Australia (HFA), the Goldman risk score and the Thrombolysis in Myocardial Infarction risk score (TIMI RS).

METHODS: This prospective observational study evaluated ED patients aged ≥30 years with non-traumatic chest pain for which no definitive non-ischemic cause was found. Data collected included demographic and clinical information, investigation findings and occurrence of MACE by 30 days. The outcome of interest was the comparative predictive performance of the risk tools for MACE at 30 days, as analyzed by receiver operator curves (ROC).

RESULTS: Two hundred eighty-one patients were studied; the rate of MACE was 14.1%. Area under the curve (AUC) of the HFA, TIMI RS and Goldman tools for the endpoint of MACE was 0.54, 0.71 and 0.67, respectively, with the difference between the tools in predictive ability for MACE being highly significant [chi2 (3) = 67.21, N = 276, p < 0.0001].

CONCLUSION: The TIMI RS and Goldman tools performed better than the HFA in this undifferentiated ED chest pain population, but selection of cutoffs balancing sensitivity and specificity was problematic. There is an urgent need for validated risk stratification tools specific for the ED chest pain population.

Item Details

Item Type:Refereed Article
Keywords:Chest pain; Emergency department; Goldman risk score; Risk score; TIMI
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Marwick, T (Professor Tom Marwick)
ID Code:96421
Year Published:2014
Deposited By:Menzies Institute for Medical Research
Deposited On:2014-11-05
Last Modified:2017-11-02

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