Validation of the Vancouver Chest Pain Rule: A Prospective Cohort Study
Academic Emergency Medicine, 07/17/2012
Jalili M et al. – This study showed a lower sensitivity and higher specificity when applying the Vancouver Chest Pain Rule to this population as compared to the original study.Methods
- A prospective cohort study was conducted on consecutive patients 25years of age and older presenting to the ED with a chief complaint of acute chest pain during January 2009 to July 2009.
- According to the Vancouver Chest Pain Rule, cardiac history, chest pain characteristics, physical and electrocardiogram (ECG) findings, and cardiac biomarker measurement (creatine kinase–myocardial band isoenzyme [CK–MB]) were used to identify patients with very low risk for developing acute coronary syndrome (ACS) in 30days.
- The primary outcome was defined as developing ACS (myocardial infarction or non–ST–elevation myocardial infarction [MI]/unstable angina) within 30days of ED presentation, and all diagnoses were made using predefined explicit criteria.
- Sensitivity, specificity, positive predictive value, and negative predictive value were calculated.
- Of 593 patients who were eligible for evaluation, 39 (6.6%) developed MI and 43 (7.3%) developed unstable angina.
- Among all patients, 292 (49.2%) patients could have been assigned to the very–low–risk group and discharged after a brief ED assessment according to the Vancouver Chest Pain Rule.
- Among these patients, four (1.4%) developed ACS within 30days.
- Sensitivity of the rule was 95.1% (95% confidence interval [CI]=88.0% to 98.7%), specificity was 56.3% (95% CI=52.0% to 60.7%), positive prediction value was 25.9% (95% CI=21.0% to 31.0%), and negative prediction value was 98.6% (95% CI=96.5% to 99.6%).