Original Articles
Vol. 20 No. 1 (2026)
https://doi.org/10.4081/itjm.2026.2377

Standardized emergency department protocol for non-traumatic chest pain: experience from the USL Umbria 1 Health Authority

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Published: 22 January 2026
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Chest pain, acute coronary syndrome, emergency department, triage, HEART score

Authors

Manuel Monti
montimanuel@tiscali.it
https://orcid.org/0000-0003-0478-110X
Emergency Department, Gubbio Gualdo Tadino Hospital, Gubbio, Italy.
Giovanni Dorilli
Emergency Department, Gubbio Gualdo Tadino Hospital, Gubbio, Italy.
Laura Gasperini
Emergency Department, Gubbio Gualdo Tadino Hospital, Gubbio, Italy.
Michele Marvardi
Emergency Department, Gubbio Gualdo Tadino Hospital, Gubbio, Italy.

This document describes the standardized corporate procedure developed by the USL Umbria 1 Health Authority to standardize the multidisciplinary approach to patients presenting with non-traumatic chest pain across its network of emergency departments, a common presentation requiring rapid differentiation between life-threatening conditions [e.g., acute coronary syndrome (ACS), aortic dissection, pulmonary embolism] and benign etiologies. The protocol mandates a structured pathway focusing on early risk stratification, including a 12-lead electrocardiogram (ECG) within 10 minutes of arrival and a comprehensive assessment to determine initial triage priority. For suspected ACS, the procedure involves serial cardiac biomarker (troponin) measurement (T0, T3h, and T6h) and HEART Score calculation to estimate the 30-day risk of major adverse cardiovascular events. High-risk patients (HEART Score 7 or clinically unstable) receive immediate cardiology consultation. Specifically for diagnosed ST-elevation myocardial infarction (STEMI) cases, the protocol integrates with the regional Umbria STEMI Network, ensuring immediate activation of the 118 emergency service for rapid secondary transport from spoke/antenna hospitals to a primary percutaneous coronary intervention (pPCI) hub center, with pPCI being the preferred reperfusion strategy and fibrinolysis reserved only if the time to pPCI exceeds 110-120 minutes from the first medical contact. Bedside echocardiography is an encouraged tool for rapid differential diagnosis and left ventricular function assessment. The implementation of this standardized, evidence-based protocol, integrated with the regional STEMI Network and leveraging rapid ECG teletransmission and risk scoring tools (Chest Pain Score, HEART), aims to ensure timely, guideline-driven, and appropriate care for all patients with non-traumatic chest pain across the USL Umbria 1 Emergency Departments.

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Standardized emergency department protocol for non-traumatic chest pain: experience from the USL Umbria 1 Health Authority. (2026). Italian Journal of Medicine, 20(1). https://doi.org/10.4081/itjm.2026.2377
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