Comparison of clinical risk scores for triaging high-risk chest pain patients at the emergency department.
Comparison of clinical risk scores for triaging high-risk chest pain patients at the emergency department.
复制标题
DOI：
10.1016/j.ajem.2018.06.020
复制
发表时间：
2019-03
期刊：
影响因子：
--
通讯作者：
Callaway C
中科院分区：
文献类型：
--
作者：
Al-Zaiti SS;Faramand Z;Alrawashdeh MO;Sereika SM;Martin-Gill C;Callaway C
许多常规用于胸痛评估的临床风险评分尚未在急性冠状动脉综合征（ACS）高危患者中得到验证。我们对HEART、TIMI、GRACE、FRISC和PURSUIT评分进行了独立比较，以识别ACS所致胸痛，并预测通过急诊医疗服务（EMS）到达的患者的30天死亡或再梗死。我们招募了连续的EMS患者在三个急诊科评估胸痛。对结果数据不知情的审查者回顾性审查了患者图表，以计算每个风险评分。主要结局是初次入院时诊断的ACS，次要结局是初次就诊后30天内的死亡或再梗死。我们的样本包括750例患者（年龄59±17岁，42%为女性），其中115例（15.3%）患有ACS，33例（4.4%）在30天内死亡或再梗死。HEART、TIMI、GRACE、FRISC和PURSUIT识别ACS的c统计量分别为0.87、0.86、0.73、0.84和0.79，预测30天死亡或再梗死的c统计量分别为0.70、0.73、0.72、0.72和0.62。HEART≥4和TIMI≥3诊断ACS的敏感性/阴性预测值分别为0.94 / 0.98和0.87 / 0.97。在通过EMS入院的胸痛患者中，HEART和TIMI在识别ACS所致胸痛方面优于其他评分。虽然两者具有相似的阴性预测值，但HEART具有更好的灵敏度和更低的假阴性结果率，因此在该人群的初始分诊中，它可以优先于TIMI使用。
Many of the clinical risk scores routinely used for chest pain assessment have not been validated in patients at high risk for acute coronary syndrome (ACS). We performed an independent comparison of HEART, TIMI, GRACE, FRISC, and PURSUIT scores for identifying chest pain due to ACS and for predicting 30-day death or re-infarction in patients arriving through Emergency Medical Services (EMS). We enrolled consecutive EMS patients evaluated for chest pain at three emergency departments. A reviewer blinded to outcome data retrospectively reviewed patient charts to compute each risk score. The primary outcome was ACS diagnosed during the primary admission, and the secondary outcome was death or re-infarction within 30-days of initial presentation. Our sample included 750 patients (aged 59±17 years, 42% female), of whom 115 (15.3%) had ACS and 33 (4.4%) had 30-day death or re-infarction. The c-statistics of HEART, TIMI, GRACE, FRISC, and PURSUIT for identifying ACS were 0.87, 0.86, 0.73, 0.84, and 0.79, respectively, and for predicting 30-day death or re-infarction were 0.70, 0.73, 0.72, 0.72, and 0.62, respectively. Sensitivity / negative predictive value of HEART≥4 and TIMI≥3 for ACS detection were 0.94 / 0.98 and 0.87 / 0.97, respectively. In chest pain patients admitted through EMS, HEART and TIMI outperform other scores for identifying chest pain due to ACS. Although both have similar negative predictive value, HEART has better sensitivity and lower rate of false negative results, thus it can be used preferentially over TIMI in the initial triage of this population.
登录
查看更多内容
影响因子：
1.3
作者：
Al-Zaiti, Salah S.;Martin-Gill, Christian;Callaway, Clifton
通讯作者：
Callaway, Clifton
影响因子：
--
作者：
Granger, CB;Goldberg, RJ;Fox, KAA
通讯作者：
Fox, KAA
影响因子：
3.5
作者：
Backus, B. E.;Six, A. J.;Doevendans, P. A.
通讯作者：
Doevendans, P. A.
影响因子：
2
作者：
Six, A. J.;Backus, B. E.;Kelder, J. C.
通讯作者：
Kelder, J. C.
影响因子：
1.9
作者：
Backus, B. E.;Six, A. J.;Doevendans, P. A.
通讯作者：
Doevendans, P. A.