The new Vancouver Chest Pain Rule using troponin as the only biomarker: an external validation study

Cullen, L., Greenslade, J.H., Than, M., Brown, A.F.T., Hammett, C.J., Lamanna, A., Flaws, D.F., Chu, K., Fowles, L.F. and Parsonage, W.A. (2014) The new Vancouver Chest Pain Rule using troponin as the only biomarker: an external validation study. American Journal of Emergency Medicine, 32 2: 129-134. doi:10.1016/j.ajem.2013.10.021

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Author Cullen, L.
Greenslade, J.H.
Than, M.
Brown, A.F.T.
Hammett, C.J.
Lamanna, A.
Flaws, D.F.
Chu, K.
Fowles, L.F.
Parsonage, W.A.
Title The new Vancouver Chest Pain Rule using troponin as the only biomarker: an external validation study
Journal name American Journal of Emergency Medicine   Check publisher's open access policy
ISSN 0735-6757
1532-8171
Publication date 2014-02-01
Year available 2013
Sub-type Article (original research)
DOI 10.1016/j.ajem.2013.10.021
Open Access Status Not Open Access
Volume 32
Issue 2
Start page 129
End page 134
Total pages 6
Place of publication Maryland Heights, MO, U.S.A.
Publisher W.B. Saunders
Language eng
Subject 2711 Emergency Medicine
Abstract Objectives: To externally evaluate the accuracy of the new Vancouver Chest Pain Rule and to assess the diagnostic accuracy using either sensitive or highly sensitive troponin assays. Methods: Prospectively collected data from 2 emergency departments (EDs) in Australia and New Zealand were analysed. Based on the new Vancouver Chest Pain Rule, low-risk patients were identified using electrocardiogram results, cardiac history, nitrate use, age, pain characteristics and troponin results at 2 hours after presentation. The primary outcome was 30-day diagnosis of acute coronary syndrome (ACS), including acute myocardial infarction, and unstable angina. Sensitivity, specificity, positive predictive values and negative predictive values were calculated to assess the accuracy of the new Vancouver Chest Pain Rule using either sensitive or highly sensitive troponin assay results. Results: Of the 1635 patients, 20.4% had an ACS diagnosis at 30 days. Using the highly sensitive troponin assay, 212 (13.0%) patients were eligible for early discharge with 3 patients (1.4%) diagnosed with ACS. Sensitivity was 99.1% (95% CI 97.4-99.7), specificity was 16.1 (95% CI 14.2-18.2), positive predictive values was 23.3 (95% CI 21.1-25.5) and negative predictive values was 98.6 (95% CI 95.9-99.5). The diagnostic accuracy of the rule was similar using the sensitive troponin assay. Conclusions: The new Vancouver Chest Pain Rule should be used for the identification of low risk patients presenting to EDs with symptoms of possible ACS, and will reduce the proportion of patients requiring lengthy assessment; however we recommend further outpatient investigation for coronary artery disease in patients identified as low risk.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes published online 14 November 2013.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
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Created: Fri, 14 Mar 2014, 18:34:17 EST by Matthew Lamb on behalf of School of Medicine