• Clinical decision rules
• acute coronary syndromes
• sensitivity and specificity
• diagnosis
• cardiac care
• diagnosis
• cardiac care
• acute myocardial infarct
• cardiac care
• acute coronary syndrome
• wounds
• assessment

In this issue of Emergency Medicine Journal, Steurer et al report a systematic review of clinical decision rules (CDRs) for suspected cardiac chest pain.1 These patients may account for up to 6% of Emergency Department (ED) workload, and the majority are hospitalised for investigation even though only a minority actually prove to have an acute coronary syndrome (ACS).2 It is therefore not surprising that there have been many attempts to develop a CDR to improve diagnosis in the ED for this important patient group. However, it is perhaps surprising to learn that only two CDRs have been validated in the troponin era and no CDRs have been validated using a contemporary gold standard.3 Notwithstanding this obvious drawback, Steurer et al have …