What is the utility of an accelerated diagnostic protocol for detecting patients with benign conditions versus those who require admission for serious disease?
The utility of an accelerated diagnostic protocol for detecting patients with benign conditions versus those who require admission for serious disease has been established. At minimum, these protocols involve serial ECGs and troponin measurements, both of which can be performed in the ED, a separate chest pain unit, or a telemetry unit. A 30-day negative predictive value >99% for ACS has been reported for patients presenting to the ED with chest pain who undergo a 2-hour accelerated diagnostic protocol composed of a TIMI risk score of 0, normal ECG, and normal high-sensitivity troponin at 0 hours and 2 hours (assuming appropriate follow-up care). Coronary CT angiography is associated with rapid assessment, high negative predictive value, decreased length of stay, and potentially increased accuracy; however, in the latter studies, it increased the rate of invasive coronary angiography and revascularization with uncertain long-term benefits in low-risk patients without ECG or troponin abnormalities.