Evaluation of the Marburg Heart Score and INTERCHEST score compared to current telephone triage for chest pain in out-of-hours primary care.
Neth Heart J
; 31(4): 157-165, 2023 Apr.
Article
em En
| MEDLINE
| ID: mdl-36580267
ABSTRACT
INTRODUCTION:
Chest pain is a common and challenging symptom for telephone triage in urgent primary care. Existing chest-pain-specific risk scores originally developed for diagnostic purposes may outperform current telephone triage protocols.METHODS:
This study involved a retrospective, observational cohort of consecutive patients evaluated for chest pain at a large-scale out-of-hours primary care facility in the Netherlands. We evaluated the performance of the Marburg Heart Score (MHS) and INTERCHEST score as stand-alone triage tools and compared them with the current decision support tool, the Netherlands Triage Standard (NTS). The outcomes of interest were Cstatistics, calibration and diagnostic accuracy for optimised thresholds with major events as the reference standard. Major events are a composite of all-cause mortality and both cardiovascular and non-cardiovascular urgent underlying conditions occurring within 6 weeks of initial contact.RESULTS:
We included 1433 patients, 57.6% women, with a median age of 55.0 years. Major events occurred in 16.4% (nâ¯= 235), of which acute coronary syndrome accounted for 6.8% (nâ¯= 98). For predicting major events, Cstatistics for the MHS and INTERCHEST score were 0.74 (95% confidence interval 0.70-0.77) and 0.76 (0.73-0.80), respectively. In comparison, the NTS had a C-statistic of 0.66 (0.62-0.69). All had appropriate calibration. Both scores (at threshold ≥â¯2) reduced the number of referrals (with lower false-positive rates) and maintained equal safety compared with the NTS.CONCLUSION:
Diagnostic risk stratification scores for chest pain may also improve telephone triage for major events in out-of-hours primary care, by reducing the number of unnecessary referrals without compromising triage safety. Further validation is warranted.
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Bases de dados:
MEDLINE
Tipo de estudo:
Guideline
/
Prognostic_studies
Idioma:
En
Revista:
Neth Heart J
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Holanda