title: Prognostic value of the Duke treadmill score for emergency department patients with chest pain.
abstract: BACKGROUND
  The potential clinical utility of the Duke Treadmill Score (DTS) in the Emergency Department (ED) to risk-stratify patients with chest pain but negative cardiac biomarkers and non-diagnostic electrocardiograms is unclear.
  
  
  OBJECTIVE
  We evaluated whether DTS was associated with 30-day adverse cardiac outcomes for low-risk ED patients with chest pain.
  
  
  METHODS
  For this prospective, observational cohort study, the primary outcome was any of the following at 30 days: cardiac death, myocardial infarction, or coronary revascularization. DTS risk categories (low, intermediate, high) were compared with 30-day cardiac outcomes.
  
  
  RESULTS
  We enrolled 191 patients, of whom 20 (10%) were lost to follow-up, leaving 171 patients (mean age 53.3 +/- 12.4 years, 54% female, 3.5% adverse event rate) for evaluation. Sensitivity and specificity of DTS for 30-day events were 83.3% and 71.5%, respectively, with a 99.2% negative predictive value (confidence interval 95.4-99.9) for 30-day event-free survival.
  
  
  CONCLUSIONS
  In this cohort of low-risk ED patients with chest pain, DTS demonstrated excellent negative predictive value for 30-day event-free survival and facilitated safe disposition of a large subset of patients.
authors.affiliation: Harvard Affiliated Emergency Medicine Residency, USA.
authors.forename: Alex F
authors.initials: AF
authors.lastname: Manini
authors.forename: Andrew T
authors.initials: AT
authors.lastname: McAfee
authors.forename: Vicki E
authors.initials: VE
authors.lastname: Noble
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Bohan
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain; D052279:Creatine Kinase, MB Form / Q000097:blood; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I; D052279:Creatine Kinase, MB Form