{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T15:05:01Z","timestamp":1779894301089,"version":"3.53.1"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,3,19]],"date-time":"2019-03-19T00:00:00Z","timestamp":1552953600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Key R&D Program of China","award":["2017YFC0908700"],"award-info":[{"award-number":["2017YFC0908700"]}]},{"name":"National Key R&D Program of China","award":["2017YFC0908703"],"award-info":[{"award-number":["2017YFC0908703"]}]},{"name":"Key R&D Program of Shandong Province","award":["2018GSF118003"],"award-info":[{"award-number":["2018GSF118003"]}]},{"name":"Key R&D Program of Shandong Province","award":["2016ZDJS07A14"],"award-info":[{"award-number":["2016ZDJS07A14"]}]},{"name":"Key R&D Program of Shandong Province","award":["2016GSF201235"],"award-info":[{"award-number":["2016GSF201235"]}]},{"name":"Taishan Young Scholar Program of Shandong Province","award":["tsqn20161065"],"award-info":[{"award-number":["tsqn20161065"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Symptom is still indispensable for the stratification of chest pain in the emergency department. However, it is a sophisticated aggregation of several aspects of characteristics and effective combination of those variables remains deficient. We aimed to develop and validate a chest pain symptom score (CPSS) to address this issue.<\/jats:p><\/jats:sec><jats:sec><jats:title>Hypothesis<\/jats:title><jats:p>The CPSS may help stratifying acute undifferentiated chest pain in ED.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with non\u2010ST segment elevation chest pain and negative cardiac troponin (cTn) over 3 hours after symptom onset were consecutively recruited as the derivation cohort. Logistic regression analyses identified statistical predictors from all symptom aspects for 30\u2010day acute myocardial infarction (AMI) or death. The performance of CPSS was compared with the symptom classification methods of the history variable in the history, electrocardiograph, age, risk factors, troponin (HEART) score. This new model was validated in a separated cohort of patients with negative cTn within 3\u2009hours.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven predictors in four aspects of chest pain symptom were identified. The CPSS was an independent predictor for 30\u2010day AMI or death (<jats:italic>P<\/jats:italic> &lt; 0.001). In the derivation (n\u2009=\u20091434) and validation (n\u2009=\u2009976) cohorts, the expected and observed event rates were well calibrated (Hosmer\u2013Lemeshow test <jats:italic>P<\/jats:italic> &gt; 0.30), and the c\u2010statistics of CPSS were 0.72 and 0.73, separately, significantly better than the previous history classifications in HEART score (<jats:italic>P<\/jats:italic> &lt; 0.001). Replacing the history variable with the CPSS improved the discrimination and risk classification of HEART score significantly (<jats:italic>P<\/jats:italic> &lt; 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The effective combination of isolated variables was meaningful to make the most stratification value of symptoms. This model should be considered as part of a comprehensive strategy for chest pain triage.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.23170","type":"journal-article","created":{"date-parts":[[2019,3,5]],"date-time":"2019-03-05T03:08:19Z","timestamp":1551755299000},"page":"467-475","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Effective combination of isolated symptom variables to help stratifying acute undifferentiated chest pain in the emergency department"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1098-0490","authenticated-orcid":false,"given":"Wen","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Emergency and Chest Pain Center Qilu Hospital, Shandong University  Jinan China"},{"name":"Key Laboratory of Emergency and Critical Care Medicine of Shandong Province Qilu Hospital, Shandong University  Jinan China"},{"name":"Institute of Emergency and Critical Care Medicine Shandong University  Jinan China"},{"name":"Key Laboratory of Cardiovascular Remodeling &amp; Function Research, Chinese Ministry of Education &amp; Chinese Ministry of Public Health Qilu Hospital, Shandong University  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingjing","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Emergency and Chest Pain Center Qilu Hospital, Shandong University  Jinan China"},{"name":"Key Laboratory of Emergency and Critical Care Medicine of Shandong Province Qilu Hospital, Shandong University  Jinan China"},{"name":"Institute of Emergency and Critical Care Medicine Shandong University  Jinan China"},{"name":"Key Laboratory of Cardiovascular Remodeling &amp; Function Research, Chinese Ministry of Education &amp; Chinese Ministry of Public Health Qilu Hospital, Shandong University  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Emergency and Chest Pain Center Qilu Hospital, Shandong University  Jinan China"},{"name":"Key Laboratory of Emergency and Critical Care Medicine of Shandong Province Qilu Hospital, Shandong University  Jinan China"},{"name":"Institute of Emergency and Critical Care Medicine Shandong University  Jinan China"},{"name":"Key Laboratory of Cardiovascular Remodeling &amp; 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