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To reduce emergency department (ED) chest pain observation and admission rates, a multidisciplinary task force designed and implemented a triage protocol using quantitative symptom scoring (HEART score) and biomarkers for myocardial damage. High-sensitivity troponin-T (hs-TnT) has been shown to be an effective tool in diagnosing patients with suspected acute coronary syndrome (ACS) in the ED.1 2 The protocol risk stratified patients by HEART score and hs-TnT into low risk (HEART score 0–3 and normal hs-TnT in two separate measurements in 2-hour intervals), intermediate risk (HEART score 4–6 and hs-TnT <100 ng/L) and high risk (HEART score ≥7 or hs-TnT ≥100 ng/L).2 3 Normal values of hs-TnT were defined according to the manufacturer labelling of sex-specific 99th percentile from healthy reference population (females <14 ng/L; males <22 ng/L). By the protocol, patients with low risk for ACS can be discharged with close follow-up. Patient with high risk for ACS would be admitted to the hospital for further workup while those with intermediate risk were to undergo same, or next day, cardiovascular imaging with subsequent decision to admit or discharge home. The protocol was implemented in March 2019.
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Contributors We certify that all individuals listed as authors of this manuscript have participated in conceptualising the research or content of the manuscript, in writing or critically editing the manuscript, and/or in analysis of data presented in the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.