Impact of a Clinical Decision Rule on Hospital Triage of Patients With Suspected Acute Cardiac Ischemia in the Emergency Department
(JAMA. 2002;288:342-350)

 
 

 
Figure 1. Clinical Decision Rule for Patients With Suspected Acute Cardiac Ischemia in the Emergency Department (ED)
 
* Modification to Goldman's prediction rule: Left bundle-branch block not known to be old was also considered evidence of ischemia on ECG.
†Unstable ischemic heart disease was defined as a worsening of previously stable angina, the new onset of postinfarction angina or angina after a coronary revascularization procedure, or pain that was the same as that associated with a prior MI.
‡Cardiology consultation in the ED (for possible admission to the coronary care unit) was recommended for patients stratified as high risk, which included patients who had experienced a major complication in the ED (eg, cardiogenic shock). Modification to Goldman's prediction rule: Cardiology consultation for possible coronary care unit admission was also recommended for 2 subgroups of patients: (1) patients stratified as moderate risk by the original prediction rule because they had acute pulmonary edema or ongoing angina despite maximal medical therapy in the ED, and (2) patients presenting with unstable angina within 2 weeks of acute MI or within 6 months of coronary revascularization. Patients stratified as moderate risk who also had a high probability of significant coronary artery disease (using the Diamond and Forrester criteria25) were recommended for cardiology consultation.