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PP17 Validation of the ESC 0/1 algorithm in the EMS setting
  1. Kristoffer Wibring1, 2,
  2. Markus Lingman3, 4,
  3. Johan Herlitz5,
  4. Angela Bång2
  1. 1Department of Ambulance and Prehospital Care, Region Halland, Sweden
  2. 2Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
  3. 3Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
  4. 4Department of Development, Halland Hospital, Sweden
  5. 5The Prehospital Research Center Western Sweden, University of Borås, Sweden


Background Chest pain is a common reason for contacting the emergency medical services (EMS). Troponins is a corner stone in ruling out high-risk conditions at the emergency department (ED) and the interest in using Troponins in the EMS setting is increasing. European Society of Cardiology (ESC) advocate the use of the 0/1 algorithm which allows rule-out after one Troponin test. However, no study has been validating the ESC 0/1 algorithm in the EMS setting.

Methods Observational cohort study including all patients with chest pain cared for by the EMS in the county of Halland, Sweden, during 2018. A blood sample was collected during the EMS mission and brought to the ED, where a high-sensitive Troponin T (hs-TnT) was analysed. The diagnosis at hospital discharge were retrieved from the hospital medical record. In total 2 917 EMS missions were included, of which 1 501 had an EMS hs-TnT test result. The sensitivity, specificity, negative and positive predictive value (NPV, PPV) of the ESC 0/1 algorithm’s ability to identify acute myocardial infarction (AMI) and other high-risk diagnoses were calculated. Applying only a hs-TnT result of <5 ng/L as rule-out cut-off.

Results For AMI identification the sensitivity was 99.4 (CI 95% 96.8-100.0), specificity 18.0 (CI 95% 19.9-20.1), PPV 13.4 (CI 95% 11.6-15.4) and NPV 99.6 (CI 95% 97.7-). Giving a rule-out rate of 16%, with <0.1% patients with AMI wrongly ruled-out.

For high-risk conditions (AMI, pulmonary embolism, aortic dissection etc.) identification the sensitivity was 98.4 (CI 95% 96.1-99.6), specificity 19.0 (CI 95% 16.1-19.1), PPV 20.0 (CI 95% 19.5-20.5) and NPV 98.3 (CI 95% 95.7-99.4), with four false negatives. Giving a rule-out rate of 16%, with <0.2% patients with high-risk conditions wrongly ruled out.

Conclusion By introducing high-sensitivity Troponins and applying the ESC 0/1 algorithm the EMS setting, high-risk conditions and especially AMI can be ruled out with high accuracy.

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