Clinical recommendation	Evidence rating	References
Determining whether chest pain is anginal, atypical anginal, or nonanginal is recommended to help determine a patient’s cardiac risk.	C	16
The Rouan decision rule is recommended to help predict which patients are at higher risk of MI.	C	17
A Wells score of less than 2 plus a normal d-dimer assay should rule out PE.	A	20, 32, 33
In patients with an abnormal d-dimer assay or a Wells score indicating moderate to high risk, helical CT and lower extremity venous ultrasound examination should be used to rule in or rule out PE.	A	33, 35
The Diehr diagnostic rule is recommended to predict the likelihood of pneumonia based on clinical findings.	A	11
Patients should be screened for panic disorder using two set questions.	C	14
Patients presenting with chest pain should have an ECG evaluation for ST segment elevation, Q waves, and conduction defects. Results should be compared with previous tracings.	C	7, 9
Serum troponin–level testing is recommended to aid in the diagnosis of MI and help predict the likelihood of death or recurrent MI within 30 days.	C	25, 28, 29
Patients with chest pain and a negative initial cardiac evaluation should have further testing with stress ECG, perfusion scanning, or angiography depending on their level of risk.	C	16
The Duke treadmill score is recommended to help predict long-term prognosis for patients undergoing stress ECG testing.	A	31