Vancouver Chest Pain Rule: A 2-hour clinical rule for early discharge of patients with suspected ACS.
Mandatory Criteria (At 2 hours)
Risk Profile
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Adult patients presenting to the emergency department with non-traumatic chest pain suspicious for ACS.
Specifically designed to identify low-risk patients who can be safely discharged after a 2-hour observation and troponin period.
Section 2
Formula & Logic
The Logic
The Vancouver Chest Pain Rule utilizes a sequential decision tree including ECG, Troponin, medical history, and physical examination findings.
Low-Risk Criteria
01
A patient is LOW-RISK if: They have a normal ECG AND normal 2-hour troponin.
02
AND NO prior history of CAD or nitrate use.
03
AND satisfy age/exam criteria: Age < 40 OR (Age 40-50 with pain reproducible by palpation).
Section 3
Pearls/Pitfalls
Why Palpation Matters
The rule importantly quantifies the clinical "hunch" that musculoskeletal pain is low risk. In patients aged 40-50, reproducibility of pain on palpation is a powerful negative predictor of ACS within this specific rule framework.
Safety Profile
The rule has a reported sensitivity of nearly 99% for 30-day MACE, making it one of the safest rapid rule-out protocols available.
Section 4
Evidence Appraisal
Original Study
Safety and efficiency of the Vancouver Chest Pain Rule to identify patients who can be safely discharged after a brief period of observation in the emergency department.
Christenson J et al. • Ann Emerg Med.. 2004;44(4):311-21. Initial derivation and validation.
Development and validation of a prediction rule for early discharge of low-risk patients with chest pain.
Scheuermeyer FX et al. • Ann Emerg Med.. 2012;59(3):165-174. Refined the rule to include 2-hour troponin measurement.
