{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T13:15:18Z","timestamp":1778505318181,"version":"3.51.4"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100018936","name":"Universit\u00e4tsklinikum Heidelberg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100018936","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Res Cardiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chest pain is the leading cause of presentations to the emergency department (ED), and the number of patients presenting with this symptom may cause overcrowding. To accelerate triage in the ED, clinical decision pathways using fast diagnostic protocols and high sensitivity cTn (hs-cTn) assays are being recommended by guidelines. However, their implementation is challenging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop an electronic health records (EHR)\u2013embedded clinical decision support system (CDSS) that helps to follow protocol recommendations, improve safety and effectiveness of triage and improve guideline-adherence regarding appropriate use of fast troponin-based protocols in patients presenting with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The CDSS was designed as a knowledge-based decision support tool based on the latest version of the 2023 ESC guideline recommended clinical decision pathways, i.e. ESC 0\/1\u00a0h and ESC 0\/2\u00a0h algorithm, and can be programmed to consider sex-specific upper limit of normal and different commercially available hs-cTn assays. Data can be entered manually or automatically. Input variables include time since symptom onset, baseline and follow-up hs-cTn levels and time intervals between blood samples. The system\u2019s output ultimately provides an unequivocal classification into a triage category, adjusted for the exact time elapsed between measurements. The tool further provides information on the need and timing of a second, or even a third hs-cTn, if two measurements are inconclusive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Perspective<\/jats:title>\n                    <jats:p>A prospective, single-centre validation study using a sequential roll-out design with alternating 2-week blocks of standard-of-care and CDSS-supported care is planned over a 24-week enrolment period. The primary endpoint is the proportion of protocol adherence. Key secondary endpoints include rates of correct triage, length of ED stay, proportion of direct discharge after rule-out in patients at low risk and the proportion of inappropriate blood draws (excessive or deferred) as an estimate for cost-effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A novel CDSS that represents a Class IIa medical software device and has already received CE mark for use in clinical routine. It is expected to improve guideline adherence, effectiveness and safety of patients admitted to an ED with suspected NSTE-ACS. A prospective pilot study for validation is planned.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-026-02926-2","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T12:44:55Z","timestamp":1778503495000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development of a guideline-based clinical decision support system for emergency department assessment of suspected non-ST-elevation acute coronary syndromes"],"prefix":"10.1007","author":[{"given":"Christoph","family":"Reich","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Salbach","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa","family":"Yildirim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Hilbel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hauke","family":"Hund","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norbert","family":"Frey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugo A.","family":"Katus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1025-2872","authenticated-orcid":false,"given":"Evangelos","family":"Giannitsis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"issue":"342","key":"2926_CR1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d2983.PMID:21632665;PMCID:PMC3106148","volume":"1","author":"A Guttmann","year":"2011","unstructured":"Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA (2011Jun) Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. 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He received honoraria for lectures from Roche Diagnostics, AstraZeneca, Bayer, Daiichi-Sankyo, Lilly Eli Deutschland. He serves as a consultant for Roche Diagnostics, BRAHMS Thermo Fisher Scientific, Boehringer Ingelheim and has received research funding from BRAHMS Thermo Fisher Scientific, Roche Diagnostics, Bayer Vital and Daiichi Sankyo. CR has received honoraria for lectures from Roche Diagnostics and AstraZeneca, travel support from Bayer and AstraZeneca, and research funding from AstraZeneca and Cardisio. NF has received speaker honoraria from Daiichi Sankyo, Astra Zeneca, Boehringer Ingelheim and Bayer Vital. He serves as a consultant for CMS. There are no disclosures for MY, TH, HH and CS.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}}]}}