Triage Rule-out Using Sensitive Troponin (TRUST): Study of early risk-stratification of suspected cardiac chest pain and initiation of 1-hour high-sensitivity troponin testing in very low and low-risk Emergency Department patients

An Accelerated Diagnostic Pathway incorporating the Modified Goldman Criteria and 1-hour high-sensitivity troponin testing to identify low-risk Emergency Department patients with chest pain who may be suitable for immediate discharge

Status

Active, not recruiting

Phases

Unknown

Study type

Observational

Source

ISRCTN

Registry ID

ISRCTN21109279

Enrollment

1200

Registered

2013-03-07

Start date

2012-11-01

Completion date

Unknown

Last updated

2017-10-02

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Chest pain Signs and Symptoms Chest pain, unspecified

Interventions

All patients with chest pain of suspected cardiac origin and a normal ECG on arrival in the Emergency Department will be screened to undergo blood sampling for high-sensitivity Troponin testing within

Eligibility

Sex/Gender

All

Inclusion criteria

Inclusion criteria: 1. Consenting adults (age 18-79) presenting to the Emergency Department with at least 5 minutes of chest pain (or discomfort) suggestive of acute coronary syndromes for whom attending clinicians are planning further assessment with delayed (6 hour) troponin testing 2. Possible symptoms suggestive of acute coronary syndromes include acute chest, epigastric, neck, jaw or arm pain; or chest discomfort or pressure without an apparent non-cardiac source.

Exclusion criteria

Exclusion criteria: 1. Age 79 2. Patients with ischaemic initial electrocardiogram (ECG) or ST-elevation infarct 3. Atypical symptoms (fatigue, nausea, vomiting, diaphoresis, faintness and back pain) in the absence of chest pain or discomfort 4. An alternative cause of chest pain is suspected at presentation (e.g. pulmonary embolus, dissection, pneumothorax) 5. Refusal of patient consent 6. Renal failure requiring dialysis 7. Unable to speak English language 8. Follow-up will be impossible 9. Trauma with suspicion of myocardial contusion 10. Another medical condition that necessitates hospital admission 11. Prisoners 12. Pregnancy

Design outcomes

Primary

Measure	Time frame
The proportion of very low or low-risk patients (established using the modified Goldman risk score) with a troponin blood result of <14ng/l at 1 hour with no major adverse cardiac events at 30 days after initial presentation (including initial hospital attendance)	—

Secondary

Measure	Time frame
1. The accuracy of Emergency Department nursing staff risk assessment using the modified Goldman risk score to determine very low/low clinical risk in comparison with doctor risk assessment using the same score 2. Patient opinion as to whether a prolonged period of admission and observation is required for reassurance in this low-risk group	—

Countries

United Kingdom

Outcome results

None listed

Source: ISRCTN (via WHO ICTRP) · Data processed: Feb 4, 2026