Will We Ever Feel Comfortable Sending Low-Risk Chest-Pain Patients Home from the ED?

Despite myriad studies, there is no consensus on which patients with undifferentiated chest pain who are thought to be at low risk for acute coronary syndrome (ACS) can safely be discharged. In a prospective cohort study, researchers in Canada developed a clinical prediction rule to identify patients at very low risk (<2%) of ACS who could safely be discharged within 2 to 3 hours after emergency department arrival.

A total of 769 patients older than 25 who presented to a single ED with chest pain were enrolled. The authors used risk factors, pain characteristics, physical examination findings, ECG findings, and cardiac markers to develop the rule. Patients younger than 40 with a normal ECG and no previous ischemic chest pain were at very low…