title: A clinical scoring system in undifferentiated chest pain predicting undetectable troponin concentration.
abstract: BACKGROUND
  Chest pain is the most common reason for emergency admission to hospital, but the majority of these are due to non-cardiac pain. We sought to determine which combination of clinical features is more likely to predict an undetectable troponin level in patients presenting with chest pain.
  
  
  METHODS
  We collected data over a two-month period on consecutive patients presenting acutely to hospital with chest pain and who had a troponin I measured. We recorded basic demographics, risk factors, pain distribution, associated symptoms, physical findings and ECG changes. The parameters significantly associated with troponin positivity were entered into a stepwise logistic regression analysis and the resulting model's coefficients were used to construct a simple clinical score to categorise patients into low, medium or high probability of having a positive troponin.
  
  
  RESULTS
  26 of 157 (16.6%) patients had a positive troponin. The variables retained in the regression model were: age >65, heart rate >80, previous myocardial infarction, diabetes and pain radiating to either arm. The model showed good discrimination (area under ROC curve 0.869, 95% CI 0.806 - 0.917). Using the regression model's coefficients, patients were grouped into low, intermediate or high probability groups. Being in the low probability group had a negative predictive value of 97.8% and being in the high probability group had a positive predictive value of 65.2%. The majority (73.9%) of patients could be categorised as either low or high probability.
  
  
  CONCLUSIONS
  This simple scoring system, if prospectively validated, may be useful in identifying low risk patients with chest pain who are unlikely to have elevation of serum troponin concentration.
authors.affiliation: Centre for Cardiovascular Research, Chancellors Building, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
authors.forename: Colin Gordon
authors.initials: CG
authors.lastname: Stirrat
authors.forename: Allan David
authors.initials: AD
authors.lastname: Cameron
authors.forename: Nicholas Linton
authors.initials: NL
authors.lastname: Mills
authors.forename: Francis Gerard
authors.initials: FG
authors.lastname: Dunn
keywords: Chest pain; Clinical score; Troponin
references.citation: J Interv Cardiol. 2008 Apr;21(2):129-39
references.pmid: 18248355
references.citation: Acad Emerg Med. 2002 Mar;9(3):203-8
references.pmid: 11874776
references.citation: JAMA. 1998 Oct 14;280(14):1256-63
references.pmid: 9786377
references.citation: Arch Intern Med. 2006 Dec 11-25;166(22):2446-54
references.pmid: 17159009
references.citation: Br Heart J. 1989 Aug;62(2):118-22
references.pmid: 2765325
references.citation: Ann Emerg Med. 2005 Dec;46(6):525-33
references.pmid: 16308068
references.citation: Heart. 2011 Feb;97(3):190-6
references.pmid: 20884788
references.citation: Br J Gen Pract. 1999 Jul;49(444):551-4
references.pmid: 10621990
references.citation: Ann Emerg Med. 2006 Jan;47(1):1-10
references.pmid: 16387209
references.citation: JAMA. 2005 Nov 23;294(20):2623-9
references.pmid: 16304077
references.citation: Heart. 2005 Feb;91(2):229-30
references.pmid: 15657244
references.citation: N Engl J Med. 1996 Oct 31;335(18):1342-9
references.pmid: 8857017
references.citation: Am J Cardiol. 1987 Aug 1;60(4):219-24
references.pmid: 3618483
references.citation: QJM. 2003 Dec;96(12):893-8
references.pmid: 14631055
references.citation: Arch Intern Med. 2003 Oct 27;163(19):2345-53
references.pmid: 14581255
references.citation: Emerg Med J. 2009 Dec;26(12):866-70
references.pmid: 19934131