Prognostic Value of the Duke Treadmill Score for Emergency Department Patients with Chest Pain

• Published in: The Journal of emergency medicine Vol. 39; no. 2; pp. 135 - 143
• Main Authors: Manini, Alex F., MD, McAfee, Andrew T., MD, MSC, Noble, Vicki E., MD, Bohan, J. Stephen, MD, MS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2010
• Subjects: Adult; Age; Aged; Biomarkers - blood; Chest Pain; Creatine Kinase, MB Form - blood; Electrocardiography; Emergency; Emergency Service, Hospital; Exercise Test; Female; Follow-Up Studies; Humans; Male; Middle Aged; myocardial infarction; Myocardial Ischemia - blood; Myocardial Ischemia - diagnosis; Odds Ratio; Predictive Value of Tests; Prospective Studies; treadmill test; Troponin I - blood; chest pain; treadmill test; myocardial infarction
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2007.12.034

Abstract Background: The potential clinical utility of the Duke Treadmill Score (DTS) in the Emergency Department (ED) to risk-stratify patients with chest pain but negative cardiac biomarkers and non-diagnostic electrocardiograms is unclear. Objective: We evaluated whether DTS was associated with 30-day adverse cardiac outcomes for low-risk ED patients with chest pain. Methods: For this prospective, observational cohort study, the primary outcome was any of the following at 30 days: cardiac death, myocardial infarction, or coronary revascularization. DTS risk categories (low, intermediate, high) were compared with 30-day cardiac outcomes. Results: We enrolled 191 patients, of whom 20 (10%) were lost to follow-up, leaving 171 patients (mean age 53.3 ± 12.4 years, 54% female, 3.5% adverse event rate) for evaluation. Sensitivity and specificity of DTS for 30-day events were 83.3% and 71.5%, respectively, with a 99.2% negative predictive value (confidence interval 95.4–99.9) for 30-day event-free survival. Conclusions: In this cohort of low-risk ED patients with chest pain, DTS demonstrated excellent negative predictive value for 30-day event-free survival and facilitated safe disposition of a large subset of patients.