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Chest pain risk scores have become almost ubiquitous in their use in EDs internationally. Having internally and externally validated numerous risk scores, together with their use with high-sensitivity troponin (hs-cTn) assays (both T and I hs-cTn assays are available from a variety of manufacturers) over the past decade, I have turned against their use in the clinical environment, for now. Is this because I am disgruntled that not one centre, I am aware of, uses the modified Goldman risk score I spent 3 years of my life evaluating?1 Perhaps. My work evaluating the modified Goldman risk score was published over 5 years ago and at that time we found that this risk score when combined with a single hs-cTnT below the 99th percentile cut-off value taken at presentation to ED had a very high diagnostic accuracy for the rule-out of 30-day major adverse cardiac events (MACE), with a sensitivity of 98.8%. So why did it not take off? There are likely to be several reasons. The score itself is cumbersome, without a catchy acronym and these findings were from a single-centre study.
However, one key finding from this earlier work was that an undetectable (below the limit of detection; LoD) hs-cTnT result in isolation, without the need for a cumbersome risk score, had an equally high diagnostic accuracy for the rule-out of 30-day MACE and allowed over 30% of patients with chest pain to be potentially discharged after a single hs-cTnT test. The premise that single hs-cTnT below the LoD, in combination with a non-ischaemic ECG, has since been evaluated …
Contributors This is the sole work of the author after commissioning by the editorial board.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests Funding received for travel and speaker honoraria from Roche Diagnostics.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Commissioned; internally peer reviewed.
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