BACKGROUND: The evaluation of @entity662 @entity1 in the emergency department remains a costly and difficult challenge, even though a large proportion of them do not suffer from an @entity1187 . We adopted a clinical decision model, modified from the ANMCO-SIMEU recommendations, and tested its clinical usefulness by assessing: a) the rate of unnecessary hospital admissions, b) the rate of inappropriate discharges based on coronary events ( @entity1459 , @entity583 , @entity204 ) at 6 months. METHODS: Our population included 511 consecutive @entity1 with @entity662 for a period of 6 months. On the basis of the @entity662 score and individual risk factors, 383 @entity1 with normal ECG and negative troponin were classified into four categories according to the probability of @entity1187 , resulting in different lengths of hospital stay and planning of further diagnostic tests. Stress testing was mandatory within 72 h if 22 risk factors and typical @entity951 were observed. RESULTS: Inappropriate discharges and unnecessary admissions were 1% and 9.5%, respectively. The clinical decision model based on the four categories of probability was correctly applied in 83% of cases. One hundred @entity1 were diagnosed with @entity1187 . After discharge, 6 @entity1 underwent stress testing with subsequent revascularization (mean 34 days later) without experiencing new @entity299 . One @entity1 was readmitted with @entity1459 before completing non-invasive diagnostic tests. None of 297 @entity1 with atypical @entity662 , discharged without additional testing, had adverse @entity299 . CONCLUSIONS: Our clinical decision model resulted in a low rate of inappropriate discharges with a low risk of adverse events and a standard rate of unnecessary admissions. Although clinical judgment remains of paramount importance, a clinical decision model and the risk stratification of @entity1 with @entity662 lead to an improvement of quality of care.

[ XXXX in the emergency department: benefits of a management model modified from the ANMCO-SIMEU recommendations].

@entity662 :: ('MESH:D002637', 'Disease') :: ['chest pain'] @entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity1187 :: ('MESH:D054058', 'Disease') :: ['acute coronary syndrome'] @entity1459 :: ('MESH:D000789', 'Disease') :: ['unstable angina'] @entity951 :: ('MESH:D000787', 'Disease') :: ['angina'] @entity299 :: ('MESH:D006331', 'Disease') :: ['cardiac events'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarction'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death']
@entity662 :: (MESH:D002637,Disease) :: ['Chest pain']
