Improving the performance of a triage scale for chest pain patients admitted to emergency departments: combining cardiovascular risk factors and electrocardiogram
Dublin Core
Title
Improving the performance of a triage scale for chest pain patients admitted to emergency departments: combining cardiovascular risk factors and electrocardiogram
Subject
Emergency triage system, Chest pain, Acute coronary syndrome, Cardiovascular risk factors
Description
Background: The triage of patients presenting with chest pain on admission to the emergency department uses
scales based on patient clinical presentation or an electrocardiogram (ECG). These scales have diferent sensitivity and
specifcity. Although a good sensitivity allows for the prompt identifcation of high-risk patients, specifcity prevent ED
overcrowding. Moreover, ECG at triage avoids missing ST elevation myocardial infarction, which requires urgent revas‑
cularization. Our study therefore aimed to investigate whether a scale combining ECG and cardiovascular risk factors
(CVRF) improves the diagnostic performance of ED chest pain triage scale.
Methods and results: In this prospective single-center observational study involving 505 patients, the standard
ECG-based FRENCH scale was compared to a scale combining the ECG-based FRENCH scale and the patients CVRF.
The new scale was called the “modifed” FRENCH. The accuracy of patient CVRF collection was evaluated by compar‑
ing the results of triage nurses and ED physicians.
Compared with the standard FRENCH scale, the modifed FRENCH scale had an increased sensitivity (61% versus 75%)
but a decrease in specifcity (76% versus 64%) resulting in a similar diagnostic performance. Using CVRF collected
by the ED physicians, the modifed FRENCH scale had a sensitivity of 87% and a specifcity of 56% with a signifcant
improvement in his diagnostic performance compared with standard FRENCH scales. This improvement can be
explained by an accurate collection of the CVRF by physicians compared with nurses, as suggested by the weak to
moderate correlation between their respective data collection.
Conclusion: In conclusion, combining ECG and accurately collected cardiovascular risks factor improves the diag‑
nostic performance of the ECG based chest pain triage in the ED.
Trial registration: Trial registration number: NCT03913767.
scales based on patient clinical presentation or an electrocardiogram (ECG). These scales have diferent sensitivity and
specifcity. Although a good sensitivity allows for the prompt identifcation of high-risk patients, specifcity prevent ED
overcrowding. Moreover, ECG at triage avoids missing ST elevation myocardial infarction, which requires urgent revas‑
cularization. Our study therefore aimed to investigate whether a scale combining ECG and cardiovascular risk factors
(CVRF) improves the diagnostic performance of ED chest pain triage scale.
Methods and results: In this prospective single-center observational study involving 505 patients, the standard
ECG-based FRENCH scale was compared to a scale combining the ECG-based FRENCH scale and the patients CVRF.
The new scale was called the “modifed” FRENCH. The accuracy of patient CVRF collection was evaluated by compar‑
ing the results of triage nurses and ED physicians.
Compared with the standard FRENCH scale, the modifed FRENCH scale had an increased sensitivity (61% versus 75%)
but a decrease in specifcity (76% versus 64%) resulting in a similar diagnostic performance. Using CVRF collected
by the ED physicians, the modifed FRENCH scale had a sensitivity of 87% and a specifcity of 56% with a signifcant
improvement in his diagnostic performance compared with standard FRENCH scales. This improvement can be
explained by an accurate collection of the CVRF by physicians compared with nurses, as suggested by the weak to
moderate correlation between their respective data collection.
Conclusion: In conclusion, combining ECG and accurately collected cardiovascular risks factor improves the diag‑
nostic performance of the ECG based chest pain triage in the ED.
Trial registration: Trial registration number: NCT03913767.
Creator
Chiara Casarin, Anne‑Sophie Pirot, Charles Gregoire, Laurence Van Der Haert, Patrick Vanden Berghe, Diego Castanares‑Zapatero and Melanie Dechamps
Publisher
BMC Emergency Medicine
Date
(2022) 22:118
Contributor
Fajar Bagus W
Format
PDF
Language
English
Type
Text
Files
Collection
Citation
Chiara Casarin, Anne‑Sophie Pirot, Charles Gregoire, Laurence Van Der Haert, Patrick Vanden Berghe, Diego Castanares‑Zapatero and Melanie Dechamps, “Improving the performance of a triage scale for chest pain patients admitted to emergency departments: combining cardiovascular risk factors and electrocardiogram,” Repository Horizon University Indonesia, accessed March 9, 2025, https://repository.horizon.ac.id/items/show/4232.