Comparison Between Emergency Severity Index Plus Cardiac Troponin I Rapid Test and Emergency Severity Index in Patients Presenting with Low-risk Chest Pain: A Randomized Clinical Trial

Abstract

Background: There is difficulty in identifying low-risk patients with acute coronary syndrome in the emergency department (ED). Objectives: The aim of this study was to compare mistriage between the Emergency Severity Index (ESI) plus the cardiac troponin I rapid test (cTnI) and ESI among patients with chest pain. Methods: A randomized clinical trial was conducted from January to April 2019. One hundred patients with low-risk chest pain were randomly allocated to the ESI + cTnI and ESI groups. Triage levels, used resources, and mistriage rate were compared between both groups among patients discharged from the ED and admitted to the cardiac unit (CU) or coronary care unit (CCU). Results: Our samples included 100 patients (age: 52.9 ± 13.92 years; 51% female) who were equally assigned to the ESI + cTnI and ESI groups. Overtriage rate was 6% and 88% for the ESI + cTnI and ESI groups, respectively. The triage level between the ESI + cTnI and ESI groups was significantly different among patients who were discharged from the ED (3.92 vs. 3.00). Conclusions: The ESI + cTnI score seems to be more valid than the ESI scale to triage patients with low-risk chest pain. It is recommended to add cTnI to the ESI for the triage of patients with low-risk chest pain in the ED.

The Diagnostic Evaluation of the SINEH Cardiopulmonary Triage Scale and the Emergency Severity Index in the Emergency Department: A Comparative Study

“…Emergency Medicine International chest pain, adding quantitative criteria such as the rapid troponin test can reduce signifcantly mistriage. Using a cTnI in ESI to triage patients with low-risk chest pain reduced overtriage from 88% to 6% [5]. Another noteworthy issue is that the patients with MI in this study (19 patients) had positive troponin, despite having normal vital signs, and this situation increases the possibility of undertriage if the nurse underestimates patient's chest pain and fails to recognize the high-risk situation.…”

“…Tis triage scale has been developed from the fve previous triage scales used since 2016, including the cardiac triage scale, heart failure triage scale (HFTS), ESI plus PEF, ESI plus cTnI, and ESI plus PetCO 2 [2,[5][6][7][8]. Today, it is necessary to use informative or specialty scales for triage of critically ill patients and refning previous triage scales with the recent advancement of research.…”

“…Te triage nurses' clinical expertise allows them to identify high-risk situations and the probable used resources [4]. Because of the signifcant role of triage nurse, the mistriage of ESI is reported in a wide range in literature [5][6][7]. Overtriage is the most common types of mistriage in the ESI, the cause of which can be traced back to the level-2 criteria, where the "high-risk situation" can be interpreted diferently [3].…”

“…In Persian, SINEH means "chest." Tis scale evolved from the fve triage scales developed since 2016 [2,[5][6][7][8]. Tis scale was structured using criteria such as peripheral oxygen saturation (SpO 2 ), pressure of end-tidal carbon dioxide (PetCO 2 ), respiratory rate (RR), blood pressure (BP), high sensitive troponin I (hs-cTnI), peak expiratory fow (PEF), and other evidence-based risk criteria.…”

Comparison between two triage scales requires testing users who do not have a known scale, with referent scenarios including all pathologies

“…In our opinion, the rate of under- or over-triage for specific conditions is not comparable to the rate of under- or over-triage for all illness in our study. In fact, we would expect to see more overtriage in a group of patients with all chest pain than in patients presenting all conditions [ 4 ]. Similarly, the lower rate of correct answers among students than among experienced nurses confirms the importance of professional experience in using these tools.…”