TY - JOUR T1 - Prehospital risk stratification in patients with chest pain JF - Emergency Medicine Journal JO - Emerg Med J SP - 814 LP - 819 DO - 10.1136/emermed-2020-210212 VL - 38 IS - 11 AU - Dennis Sagel AU - Pieter Jan Vlaar AU - Radboud van Roosmalen AU - Ingmar Waardenburg AU - Wybe Nieuwland AU - Roelof Lettinga AU - Robert van Barneveld AU - Edward Jorna AU - Roelof Kijlstra AU - Carien van Well AU - Antoon Oomen AU - Louis Bartels AU - Rutger Anthonio AU - Vincent Hagens AU - Sjoerd Hofma AU - Youlan Gu AU - Derk Drenth AU - Ryanne Addink AU - Thea van Asselt AU - Peter van der Meer AU - Eric Lipsic AU - Luis Juarez Orozco AU - Pim van der Harst Y1 - 2021/11/01 UR - http://emj.bmj.com/content/38/11/814.abstract N2 - 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. ER -