Prognostic value of the Duke treadmill score for emergency department patients with chest pain.
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.
Manini
Alex F
AF
Harvard Affiliated Emergency Medicine Residency, USA.
McAfee
Andrew T
AT
Noble
Vicki E
VE
Bohan
J Stephen
JS
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
D015415:Biomarkers; D019210:Troponin I; D052279:Creatine Kinase, MB Form