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Systematic review with meta-analysis
Traditionally taught clinical variables and risk factors perform poorly in the prediction of acute coronary syndromes in the emergency department
  1. Martin Than
  1. Emergency Department, Christchurch Hospital, Christchurch, New Zealand
  1. Correspondence to: Dr Martin Than, Emergency Department, Christchurch Hospital, Private Bag 4710, Christchurch 8140, New Zealand; martinthan{at}

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Up to 5–10% of annual presentations to emergency departments (EDs) and 25% of hospital admissions are patients with symptoms suggestive of acute coronary syndromes (ACS). Estimating the pretest probability of ACS is important. Traditionally, this has been determined using clinical acumen, primarily involving historical variables and risk factors learnt during early training and reinforced in clinical practice. This systematic review assessed diagnostic utility of the history, physical examination and ECG to increase or decrease the estimated likelihood of ACS. It also assessed the accuracy of decision aids (risk scores) in combination with the initial ECG and troponin level.


Studies included in this systematic review had to (1) involve patients presenting to an ED with suspected …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.