Evaluation of the Marburg Heart Score and INTERCHEST score compared to current telephone triage for chest pain in out-of-hours primary care.

Autor: Manten A; Department of General Practice, Amsterdam UMC, Amsterdam Cardiovascular Sciences Research Institute, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands., De Clercq L; Department of General Practice, Amsterdam UMC, Amsterdam Cardiovascular Sciences Research Institute, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands., Rietveld RP; Huisartsenorganisatie Noord-Kennemerland, Alkmaar, The Netherlands., Lucassen WAM; Department of General Practice, Amsterdam UMC, Amsterdam Cardiovascular Sciences Research Institute, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands., Moll van Charante EP; Department of General Practice, Amsterdam UMC, Amsterdam Cardiovascular Sciences Research Institute, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.; Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands., Harskamp RE; Department of General Practice, Amsterdam UMC, Amsterdam Cardiovascular Sciences Research Institute, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. r.e.harskamp@amsterdamumc.nl.
Jazyk: angličtina
Zdroj: Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation [Neth Heart J] 2023 Apr; Vol. 31 (4), pp. 157-165. Date of Electronic Publication: 2022 Dec 29.
DOI: 10.1007/s12471-022-01745-0
Abstrakt: 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: C‑statistics, 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% (n = 235), of which acute coronary syndrome accounted for 6.8% (n = 98). For predicting major events, C‑statistics 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 ≥ 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.
(© 2022. The Author(s).)
Databáze: MEDLINE
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