title: A simple scoring tool for the evaluation of patients in an emergency department chest pain unit.
abstract: BACKGROUND
  There are multiple risk scores to determine the prognosis of high-risk patients presenting with acute coronary syndromes (ACS) to emergency departments (ED) and chest pain units (CPU), however, there are few options for patients without ACS (no diagnostic ST-segment deviation or positive biomarkers).
  
  
  OBJECTIVE
  To derive a clinical risk score for the management of lower-risk patients seen in ED CPUs.
  
  
  METHODS
  We evaluated all patients triaged through the Mount Sinai ED CPU over a 76-month period who underwent stress testing after negative serial biomarkers and ECGs. Primary and secondary endpoints of hospital admission and coronary revascularization were retrospectively obtained. Variables associated with admission at P < 0.1 level were entered into a multivariable model. Each variable was assigned an integer score based on the beta coefficients in the final model.
  
  
  RESULTS
  A total of 4,666 patients were evaluated and 738 (15.8%) had an abnormal stress test, 575 (12.3%) were admitted to the hospital, and 133 (2.9%) underwent coronary revascularization. A score consisting of age > 55 years, gender, chest pain quality (typical vs atypical), known coronary artery disease, shortness of breath, diabetes, smoking, and abnormal ECG demonstrated strong correlation between observed vs predicted hospital admission. The clinical score showed good ability to predict admission with a receiver operating characteristic (ROC) area of 0.72, which improved to 0.81 when the results of stress testing were added.
  
  
  CONCLUSIONS
  This new clinical risk score is simple to use, predicts a clinically relevant outcome to ED physicians, and the results of noninvasive testing are additive.
authors.forename: W Lane
authors.initials: WL
authors.lastname: Duvall
authors.forename: Elliot
authors.initials: E
authors.lastname: Levine
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.forename: Lori B
authors.initials: LB
authors.lastname: Croft
authors.forename: Sheila
authors.initials: S
authors.lastname: Sahni
authors.forename: Sanjum
authors.initials: S
authors.lastname: Sethi
authors.forename: Luke
authors.initials: L
authors.lastname: Hermann
authors.forename: Mohammadtokir
authors.initials: M
authors.lastname: Mujtaba
authors.forename: Milena J
authors.initials: MJ
authors.lastname: Henzlova
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000209:etiology*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D014218:Triage / Q000379:methods*