Clinical decision rules in the pre-hospital triage of patients with chest pain

Overcrowding in the emergency department (ED) is a growing phenomenon worldwide, which is associated with increased length of hospital stay, high healthcare costs and worse patient outcomes. With the rapidly aging population in the Netherlands and frequent ED shutdowns due to staff shortages, this problem will probably not decrease in the near future. Chest pain is responsible for about 10% of all ED visits. It is important to rapidly diagnose or exclude life-threatening causes of chest pain. When an acute coronary syndrome (ACS) is suspected, the diagnostic work-up is a combination of a 12-lead electrocardiogram (ECG), clinical evaluation and cardiac troponin measurement(s) If the ECG shows signs of an STsegment elevation myocardial infarction, the diagnosis is relatively straightforward. However, in more than 30% of the patients with a non-ST-segment elevation ACS (NSTE-ACS), the ECG is normal Therefore, chest pain patients with a suspected NSTE-ACS are often transported to the ED for further evaluation. However, 80-90% of the chest pain patients at the ED do not have an ACS Pre-hospital identification of patients without an ACS could therefore prevent unnecessary referrals, reduce overburdening of ambulance services and reduce ED overcrowding.