The Association Between Patient Outcomes and the Initial Emergency Severity Index Triage Score in Patients With Suspected Acute Coronary Syndrome.
Stephanie O Frisch, Ziad Faramand, Brandi Leverknight and 6 others
PMID 31977564WHAT IT FOUND
In ambulance-arrived patients with suspected acute coronary syndrome, ESI triage scores poorly identified major adverse cardiac events.
Supplementing ESI with a modified HEAR/T score without troponin reclassified many patients mis-triaged by ESI.
Key findings
01Most patients were triaged as ESI 2, and major adverse cardiac events occurred in about 36% of ESI 1 patients, 16% of ESI 2 patients, and 9% of ESI 3 patients.
02For predicting major adverse cardiac events, an ESI score of 2 or less had sensitivity 75% and specificity 32%, while a modified HEAR/T score of 4 or higher had sensitivity 83% and specificity 51%.
03Supplementing the ESI score with the modified HEAR/T score reclassified 181 of 391 event-free high-acuity ESI patients as low risk and 16 of 19 middle-acuity ESI patients with events as intermediate to high risk.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was limited to ambulance-arrived patients with chest pain or equivalent symptoms, so results may not apply to walk-in patients or other chief complaints. ESI and modified HEAR/T scores were calculated from retrospective chart review, so documentation could bias the scores. 39 ESI scores were missing and were not missing at random relative to major adverse cardiac events. 30-day outcomes may have been missed if patients received care outside the health system. The modified HEAR/T score was validated for prehospital use but was applied to emergency department triage in this analysis. Because this was an observational chart review, it cannot show that changing triage practice improves patient outcomes.
Declared interests
The authors declared no conflicts of interest. The paper is listed as supported by NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not replace ESI triage for all emergency patients based on this paper. It studied only ambulance-arrived patients with suspected chest pain, and the modified HEAR/T score was calculated from charts, not tested as a triage intervention that improves outcomes.