Cardiovascular Medicine Book

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Bosner Chest Pain Decision Rule

Aka: Bosner Chest Pain Decision Rule
  1. See Also
    1. Chest Pain
    2. Acute Chest Pain Approach
    3. Angina Diagnosis
    4. Cardiac Risk Assessment
    5. Cardiac Risk Management
    6. TIMI Risk Score
    7. Bosner Chest Pain Decision Rule
    8. Cardiac Risk in Diabetes Score
    9. Chest Wall Pain Prediction Rule
    10. Framingham Score
    11. HEART Score
    12. GRACE Score
    13. Vancouver Chest Pain Rule
  2. Definition
    1. Validated Clinical Decision Rule to Predict Coronary Artery Disease as a cause of Chest Pain
  3. Indications
    1. Chest Pain Evaluation
  4. Criteria (Assign one point for each of 5 criteria)
    1. Age and gender
      1. Men at least 55 years old or
      2. Women at least 65 years old
    2. Known vascular disease
      1. Coronary Artery Disease
      2. Cerebrovascular Disease
      3. Occlusive vascular disease (e.g. Peripheral Arterial Disease)
    3. Pain worse with Exercise
    4. Pain not elicited with palpation
    5. Patient assumes pain is of cardiac origin
  5. Interpretation: Likelihood that Chest Pain is caused by CAD
    1. Score 0-1
      1. CAD Prevalence: 1%
      2. Positive Likelihood Ratio: 1.09
      3. Negative Likelihood Ratio: 0.00
    2. Score 2-3
      1. Positive Likelihood Ratio: 1.83
      2. Negative Likelihood Ratio: 0.03
    3. Score 4-5
      1. CAD Prevalence: 63%
      2. Positive Likelihood Ratio: 4.52
      3. Negative Likelihood Ratio: 0.16
  6. References
    1. Bosner (2010) CMAJ 182(12):1295-1300 [PubMed]

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