RT Journal Article
SR Electronic
T1 Prehospital risk stratification in patients with chest pain
JF Emergency Medicine Journal
JO Emerg Med J
FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine
SP emermed-2020-210212
DO 10.1136/emermed-2020-210212
A1 Dennis Sagel
A1 Pieter Jan Vlaar
A1 Radboud van Roosmalen
A1 Ingmar Waardenburg
A1 Wybe Nieuwland
A1 Roelof Lettinga
A1 Robert van Barneveld
A1 Edward Jorna
A1 Roelof Kijlstra
A1 Carien van Well
A1 Antoon Oomen
A1 Louis Bartels
A1 Rutger Anthonio
A1 Vincent Hagens
A1 Sjoerd Hofma
A1 Youlan Gu
A1 Derk Drenth
A1 Ryanne Addink
A1 Thea van Asselt
A1 Peter van der Meer
A1 Eric Lipsic
A1 Luis Juarez Orozco
A1 Pim van der Harst
YR 2021
UL http://emj.bmj.com/content/early/2021/08/08/emermed-2020-210212.abstract
AB Objectives The History, ECG, Age, Risk Factors and Troponin (HEART) Score is a decision support tool applied by physicians in the emergency department developed to risk stratify low-risk patients presenting with chest pain. We assessed the potential value of this tool in prehospital setting, when applied by emergency medical services (EMS), and derived and validated a tool adapted to the prehospital setting in order to determine if it could assist with decisions regarding conveyance to a hospital.Methods In 2017, EMS personnel prospectively determined the HEART Score, including point-of-care (POC) troponin measurements, in patients presenting with chest pain, in the north of the Netherlands. The primary endpoint was a major adverse cardiac event (MACE), consisting of acute myocardial infarction or death, within 3 days. The components of the HEART Score were evaluated for their discriminatory value, cut-offs were calibrated for the prehospital setting and sex was substituted for cardiac risk factors to develop a prehospital HEART (preHEART) Score. This score was validated in an independent prospective cohort of 435 patients in 2018.Results Among 1208 patients prospectively recruited in the first cohort, 123 patients (10.2%) developed a MACE. The HEART Score had a negative predictive value (NPV) of 98.4% (96.4–99.3), a positive predictive value (PPV) of 35.5% (31.8–39.3) and an area under the receiver operating characteristic curve (AUC) of 0.81 (0.78–0.85). The preHEART Score had an NPV of 99.3% (98.1–99.8), a PPV of 49.4% (42.0–56.9) and an AUC of 0.85 (0.82–0.88), outperforming the HEART Score or POC troponin measurements on their own. Similar results were found in a validation cohort.Conclusions The HEART Score can be used in the prehospital setting to assist with conveyance decisions and choice of hospitals; however, the preHEART Score outperforms both the HEART Score and single POC troponin measurements when applied by EMS personnel in the prehospital setting.Data are available on reasonable request. All deidentified data can and will be shared on a written reasonable request.