Brook’s idea for creating an acronym1 for Bösner and colleagues’ prediction rule2 is commendable. It would certainly facilitate the use of the score in daily clinical practice. But perhaps the acronym would be easier to remember if it was associated with the cardiovascular system — something like the PEVAsC score:
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P: pain not reproducible by palpation
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E: exercise-related pain
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V: known vascular disease
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As: age/sex (men > 55, women > 65)
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C: patient assumes pain is of cardiac origin
Careful assessment of clinical probability (estimation of the prediction score) together with other diagnostic tools (i.e., resting electrocardiogram) allows one to exclude coronary origin of chest pain with a much greater confidence than either history and physical examination or electrocardiogram alone. When differentiating chest pain in general practice, it is important that primary care physicians consider serious diseases such as acute coronary syndromes, pulmonary embolism and pneumonia, in addition to more common (but not life-threatening) conditions such as pain in the chest wall, gastroesophageal reflux disease and panic disorder.3 Existing prediction scores are valuable complementary measures that may help clarify many of these diagnoses.1,4–6