TY - JOUR
T1 - Prehospital risk stratification in patients with chest pain
AU - Sagel, Dennis
AU - Vlaar, Pieter Jan
AU - van Roosmalen, Radboud
AU - Waardenburg, Ingmar
AU - Nieuwland, Wybe
AU - Lettinga, Roelof
AU - van Barneveld, Robert
AU - Jorna, Edward
AU - Kijlstra, Roelof
AU - van Well, Carien
AU - Oomen, Antoon
AU - Bartels, Louis
AU - Anthonio, Rutger
AU - Hagens, Vincent
AU - Hofma, Sjoerd
AU - Gu, Youlan
AU - Drenth, Derk
AU - Addink, Ryanne
AU - van Asselt, Thea
AU - van der Meer, Peter
AU - Lipsic, Eric
AU - Juarez Orozco, Luis
AU - van der Harst, Pim
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2021.
PY - 2021/11
Y1 - 2021/11
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.
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.
KW - Aged
KW - Area Under Curve
KW - Chest Pain/complications
KW - Emergency Medical Services
KW - Emergency Service, Hospital/organization & administration
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Netherlands/epidemiology
KW - Prospective Studies
KW - ROC Curve
KW - Risk Assessment/methods
KW - Risk Factors
KW - Risk Management/methods
U2 - 10.1136/emermed-2020-210212
DO - 10.1136/emermed-2020-210212
M3 - Article
C2 - 34373266
SN - 1472-0205
VL - 38
SP - 814
EP - 819
JO - Emergency Medicine Journal
JF - Emergency Medicine Journal
IS - 11
M1 - 210212
ER -