Author: Bronagh MacManus, Bassey Ndoma-Egba, Ahmed Ahmed / Editor: Hridesh Chatha, Rajesh Chatha, Robert Hirst / Codes: CC1, CC2, CP1, SLO1, SLO10, SLO2 / Published: 25/11/2021

At TERN Education we are keen to help you learn how to critically evaluate the evidence base behind your practice. In order to do this, we have been producing monthly virtual journal club (VJC) modules on RCEMLearning since March 2021.

A different deanery each month creates and contribute to the Virtual Journal Club each month. This month is the turn of Ireland – or ITERN. The team was made up of emergency medicine trainees of different grades. 

The Virtual Journal Club gives you the opportunity to critically consider your practice and earn a certificate which demonstrates the new curricular requirement to be engaged in critical appraisal activity. When you finish, click the link to the forum to discuss this month’s paper with colleagues around the country. Interested in writing a module? We are looking to recruit regional teams to write future modules. Email us at [email protected].


  1. Collinson PO, Premachandram S, Hashemi K. Prospective audit of incidence of prognostically important myocardial damage in patients discharged from the emergency department; BMJ. 2000; 320(7251): 1702-5. doi:10.1136/bmj.320.7251.1702
  2. National Institute for Health and Care Excellence. Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis. [NICE guideline CG95] 2016. (Accessed 28th September 2021).
  3. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R et al. Heart Disease and Stroke Statistics – 2017 Update: A Report From the American Heart Association. Circulation. 2017; 135(10): e146-e603.
  4. Weinstock MB, Weingart S, Orth F, VanFossen D, Kaide C, Anderson J et al. Risk for Clinically Relevant Adverse Cardiac Events in Patients with Chest Pain at Hospital Admission. JAMA Intern Med. 2015; 175(7): 1207-12. doi:10.1001/jamainternmed.2015.1674.
  5. National Institute for Health and Care Excellence. Acute coronary syndromes [NICE guideline NG185] 2021. (Accessed on 28th September 2021).
  6. Royal College of Emergency Medicine. (2017). James Lind Alliance Priority Setting Partnership. (Accessed 28th September 2021).
  7. Sandoval Y, Gunsolus IL, Smith SW, et al. Appropriateness of cardiac troponin testing: insights from the use of troponin in acute coronary syndromes (UTROPIA) study. Am J Med. 2019; 132(7): 869-74. doi:10.1016/j.amjmed.2019.01.043.
  8. Backus BE, Six AJ, Kelder JC, Mast TP, van den Akker F, Mast EJ et al. Chest pain in the emergency room: a multicenter validation of the HEART score. Crit Pathw Cardiol. 2010; 9(3): 164-9.
  9. Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008; 16(6): 191–6. doi:10.1007/bf03086144
  10. Mahler S, Riley R, Hiestand B, Russell G, Hoekstra J et al. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circulation Cardiovascular Quality and Outcomes. 2015; 8(2): 195-203.
  11. Antman EM, Cohen M, Bernink PJ, McCabe CH, et al. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA. 2000; 284(7): 835-42.
  12. Morrow DA, Antman EM, Charlesworth A, Cairns R, et al. TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation An intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation. 2000; 102(17): 2031-7.
  13. Eagle KA, Lim MJ, Dabbous OH, Pieper KS, Goldberg RJ, et al. A Validated Prediction Model for All Forms of Acute Coronary Syndrome: Estimating the Risk of 6-Month Post-discharge Death in an International Registry. JAMA. 2004; 291(22): 2727–33.
  14. Than M, Flaws D, Sanders S, Doust J, Glasziou P, Kline J, et al. Development and validation of the Emergency Department Assessment of Chest pain Score and 2h accelerated diagnostic protocol. Emerg Med Australas. 2014; 26(1): 34-44. doi:10.1111/1742-6723.12164.
  15. Laureano-Phillips J, Robinson R, Aryal S, Blair S, Wilson D, et al. HEART Score Risk Stratification of Low-Risk Chest Pain Patients in the Emergency Department: A Systematic Review and Meta-Analysis. Annals of Emergency Medicine. 2019; 74(2): 187-203.
  16. Poldervaart JM, Langedijk M, Backus B, Dekker I, Six A, et al. Comparison of the GRACE, HEART and TIMI score to predict major adverse cardiac events in chest pain patients at the emergency department. International Journal of Cardiology. 2017; 227: 656-661.
  17. Nilsson T, Johannesson E, Forberg J, Mokhtari A, Ekelund U. Diagnostic accuracy of the HEART Pathway and EDACS-ADP when combined with a 0-hour/1-hour hs-cTnT protocol for assessment of acute chest pain patients. Emergency Medicine Journal. 2021; 38(11): 808-13.
  18. Flaws D, Than M, Scheuermeyer FX, Christenson J, et al. External validation of the emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP). Emergency Medicine Journal. 2016; 33(9): 618-625.
  19. Chapman A, Hesse K, Andrews J, Lee K, Anand A, Shah A et al. High-Sensitivity Cardiac Troponin I and Clinical Risk Scores in Patients With Suspected Acute Coronary Syndrome. Circulation. 2018; 138(16): 1654-1665. doi:10.1161/circulationaha.118.036426
  20. Torralba F, Navarro A, Castellanos-de la Hoz J, Ortiz C, Botero A, et al. HEART, TIMI, and GRACE Scores for Prediction of 30-Day Major Adverse Cardiovascular Events in the Era of High-Sensitivity Troponin. Arquivos Brasileiros de Cardiologia. 2020; 114(5): 795-802.
  21. Smith LM, Ashburn NP, Snavely AC, Stopyra JP, Lenoir KM, et al. Identification of very low-risk acute chest pain patients without troponin testing. Emergency Medicine Journal. 2020; 37(11): 690-695.