Table 1

The Modified Goldman Score and the TRUST accelerated diagnostic protocol (ADP)

Modified Goldman risk score1 point for each variable present
Typical new-onset chest pain at rest
Pain the same as previous myocardial infarction
Pain not relieved by glyceryl trinitrate (GTN) spray within 15 min
Pain lasting more than 60 min
Pain occurring with increasing frequency
Hypotension (systolic blood pressure <100 mm Hg)
Acute shortness of breath
Pain within 6 weeks of a myocardial infarction or revascularisation
Modified Goldman total
Trust ADP
Low risk* (Suitable for discharge)

  1. Modified Goldman score ≤1

  2. Non-ischaemic ECG

  3. Presentation high-sensitivity troponin T <14 ng/L

Not low risk

  1. Modified Goldman score >1

  2. Ischaemic ECG

  3. Presentation high-sensitivity troponin T ≥14 ng/L

  • *Safety point: protocol not validated in age ≥80 years.

  • TRUST, Triage Rule-out Using high-Sensitivity Troponin.