Validation of the Vancouver Chest Pain Rule: a prospective cohort study.
OBJECTIVE
The objective was to validate the Vancouver Chest Pain Rule in an emergency department (ED) setting to identify very-low-risk patients with acute chest pain.


METHODS
A prospective cohort study was conducted on consecutive patients 25 years 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 30 days. The primary outcome was defined as developing ACS (myocardial infarction or non-ST-elevation myocardial infarction [MI]/unstable angina) within 30 days of ED presentation, and all diagnoses were made using predefined explicit criteria. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated.


RESULTS
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 30 days. 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%).


CONCLUSIONS
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.
Emergency Medicine Department, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Mohammad
M
Jalili
Zia
Z
Hejripour
Amir Reza
AR
Honarmand
Nasim
N
Pourtabatabaei
D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis*; D000789:Angina, Unstable / Q000150:complications / Q000175:diagnosis*; D002170:Canada; D002637:Chest Pain / Q000209:etiology*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity