[Development of a novel clinical prediction model for musculoskeletal chest pain in the emergency department].

INTRODUCTION

The diagnostic work-up of patients presenting to the emergency department with chest pain remains a major clinical and health-economic challenge worldwide. Although most cases are caused by benign, non-cardiopulmonary conditions, the primary goal of emergency care is the timeous, but safe exclusion of life-threatening disorders - mainly acute coronary syndrome and pulmonary embolism. Excessive diagnostic testing increases both healthcare costs and emergency department overcrowding. Preliminary observations suggest that previously unrecognized spinal asymmetry or scoliosis is more prevalent among ambulatory adults presenting with pleuritic or musculoskeletal-type chest pain, potentially predisposing to costosternal or costovertebral subluxation as a mechanical pain generator.

OBJECTIVE

The planned prospective, multicenter study aims to assess the prevalence and clinical significance of spinal asymmetry among ambulatory, low-risk adults presenting with chest pain, and to develop/validate a novel musculoskeletal chest pain clinical prediction model.

METHODS

Primary outcome variables include pulmonary embolism and major cardiac events (non-ST-elevation myocardial infarction, unstable angina). Based on power calculations by Peduzzi et al. (1996), a total of 2,500 patients will provide adequate statistical power to avoid Type II error. Patients will be followed up at 30, 90, and 365 days for complications, recurrent visits, major adverse cardiac events, and mortality. Data will be analyzed using bootstrapping techniques for internal validation of the derived score.

EXPECTED

RESULTS

We hypothesize that spinal asymmetry independently correlates with acute musculoskeletal chest pain but does not confer an increased risk of short- or long-term mortality. The newly developed musculoskeletal chest pain clinical prediction model may facilitate early recognition and safe management of musculoskeletal chest pain in the emergency department setting.

CONCLUSION

This study is expected to refine diagnostic algorithms for low-risk chest pain, reduce unnecessary investigations, improve cost-effectiveness, and enhance patient satisfaction. Orv Hetil. 2026; 167(5): 180-187.