Document Detail

Validation of a triage flowchart to rule out acute coronary syndrome.
MedLine Citation:
PMID:  20961935     Owner:  NLM     Status:  In-Data-Review    
Objective To validate a triage flowchart to rule out acute coronary syndrome (ACS) in chest pain patients attending the emergency department (ED). Methods An observational cohort study of consecutive patients. In all cases, a previously derived five-step triage flowchart (age ≤40 years, absence of diabetes, not previously known coronary artery disease, non-oppressive and non-retrosternal pain) was applied. Patients meeting all five discriminators were grouped as 'five-step triage non-ACS', the rest as 'five-step triage ACS'. The same strategy was used with a four-step model (without age ≤40 years). After ED study and 1-month follow-up, patients were definitively classified as 'true ACS' or 'true non-ACS'. Validity indexes and receiver operating characteristics curves were calculated. Results 4231 patients were included: 918 (21.7%) were 'true ACS', 3303 (78.1%) 'true non-ACS'; 10 (0.2%) were lost to follow-up. The five-step triage flowchart classified 4000 (94.8%) as 'triage ACS' and 221 (5.2%) as 'triage non-ACS'; none of the latter was 'true ACS'. The four-step model classified 3194 (75.6%) as 'triage ACS' and 1027 (24.4%) as 'triage non-ACS'. A 'true ACS' was seen in 26 patients from the latter group. Accordingly, five-step triage flowchart specificity and positive predictive value (PPV) to rule out ACS were 100% (95% CI 100% to 100%). For the four-step model specificity and PPV were 97% (95% CI 96% to 98%). Conclusion The five-step triage flowchart identifies chest pain patients without an ACS. However, only 5% of these patients meet these five criteria. A simpler model allows greater patient inclusion but a higher risk of misclassification of true ACS.
Beatriz López; Miquel Sánchez; Ernest Bragulat; Sònia Jiménez; Blanca Coll-Vinent; Mar Ortega; Elisenda Gómez-Angelats; Oscar Miró
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Publication Detail:
Type:  Journal Article     Date:  2010-10-20
Journal Detail:
Title:  Emergency medicine journal : EMJ     Volume:  28     ISSN:  1472-0213     ISO Abbreviation:  Emerg Med J     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-09-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100963089     Medline TA:  Emerg Med J     Country:  England    
Other Details:
Languages:  eng     Pagination:  841-6     Citation Subset:  IM    
Emergency Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Catalonia, Spain;
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