How do you risk-stratify undifferentiated chest pain patients in the Emergency Department? There are a multitude of causes for chest pain. We are always taught to think of the 5 big life-threats: ACS, PE, aortic dissection, tension pneumothorax, and pericardial tamponade.
So how do YOU risk-stratify your patients for unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI)? STEMI's are usually obvious. UA and NSTEMIs -- not so much.
Fortunately a 2000 JAMA article and a followup Academic Emergency Medicine 2006 study have solidified the TIMI risk scoring system as a reasonable risk-stratification tool for all-comer ED patients with chest pain requiring an ECG.
Generally there is an upslope in risk at a TIMI score of 3 and greater.
Feel free to download this card and print on a 4'' x 6'' index card.
References
Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, Mautner B, Corbalan R, Radley D, & Braunwald E (2000). The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA : the journal of the American Medical Association, 284 (7), 835-42 PMID: 10938172
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Pollack, C., Sites, F., Shofer, F., Sease, K., & Hollander, J. (2006). Application of the TIMI Risk Score for Unstable Angina and Non-ST Elevation Acute Coronary Syndrome to an Unselected Emergency Department Chest Pain Population Academic Emergency Medicine, 13 (1), 13-18 DOI: 10.1197/j.aem.2005.06.031
