This single centre observational study recruited 458 patients with suspected cardiac chest pain. ‘Gestalt’ or clinical judgement about the probability of an ACS was assessed using a five-point Likert scale as follows: ‘definitely not’, ‘probably not’, ‘not sure’, ‘probably’ and ‘definitely’.
So, clinical gestalt alone wouldn’t cut it, with a ROC of 0.76, but with ECG and a hs-cTnT, the sensitivity was 100% in cases in which ACS was determined as ‘definitely not’ and ‘probably not’. Specificity, as with other studies, was low (<50%).
Yep, you don’t really need a score per se. Good clinical judgement, good read of the ECG and with the help of troponin (high sensitive if you have it) will help you make a good clinical decision at the bedside in the emergency department.
Limitations and caveats
Still a single centre, observational study. Not an RCT, and probably needs validation
Good sample representation – sample has significant number of AMIs and MACE – 21.8%
Well defined outcomes and good follow-up – e.g. AMI definitions and 30 day MACE
Doctors in study of varying skill level (SHOs all to way to consultants)
Still require the use of a custom-designed case report form when assessing patients – i.e. some kind of “score” already in my mind.
Single troponin only used when >12 h had already elapsed since peak symptoms, as opposed to latest ACC/AHA guidelines