Despite prolonged workup, the actual number of patients finally diagnosed with ACS is often 25 % or less. Their safe workup generally requires considerable time and often includes in-patient observation, which adds to emergency-department and hospital overcrowding. Accordingly, assessment and safe disposition of these patients is a major challenge. Patients with symptoms suggestive of acute coronary syndromes (ACS) contribute approximately 5–10 % of annual presentations to emergency departments and up to 25 % of hospital admissions. Therefore, discharge decisions in emergency medicine are difficult to make and are frequently more challenging than treatment of an immediately life-threatening disease. If the numbers are significantly low, then adopting a risk-scoring system in an early rule-out strategy is unlikely to impact upon patient flow and emergency-department overcrowding.Ĭlinicians involved in acute care often worry that patients may come to harm, soon after discharge, from the medical complaint that they presented to the hospital with. Although sensitivity and negative predictive value are the key parameters of interest when deciding to use a risk-assessment score to assist with chest-pain rule-out decision-making, it is important to consider the proportion of patients that will be classified as low risk. The trend is towards systems using clinical logic and simple criteria. Scoring systems range from those developed from statistical weighting of variables collected in observational studies to those developed from clinical judgment, logic, and common sense. Consequently, researchers are increasingly modifying or developing cardiovascular risk-scoring systems for rule-out of acute coronary syndrome in patients who present to emergency departments with chest pain. Considerable time and resources are consumed investigating the many patients who present to emergency departments but who do not have an acute coronary syndrome.
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