Prehospital prediction models based on readily available EMS variables identified high-risk chest pain conditions with an AUC of 0.85 and low-risk conditions with an AUC of 0.78.
Cohort (n=2,578)
Does a prehospital prediction model accurately identify high- and low-risk conditions in patients with acute chest pain?
A prehospital prediction model using readily available clinical variables and Troponin T can identify high- and low-risk chest pain patients with acceptable accuracy, potentially facilitating better resource allocation.
Effect estimate: AUC 0.85 for high-risk model; AUC 0.78 for low-risk model
INTRODUCTION: Chest pain is one of the most common reasons for contacting the emergency medical services (EMS). About 15% of these chest pain patients have a high-risk condition, while many of them have a low-risk condition with no need for acute hospital care. It is challenging to at an early stage distinguish whether patients have a low- or high-risk condition. The objective of this study has been to develop prediction models for optimising the identification of patients with low- respectively high-risk conditions in acute chest pain early in the EMS work flow. METHODS: This prospective observational cohort study included 2578 EMS missions concerning patients who contacted the EMS in a Swedish region due to chest pain in 2018. All the patients were assessed as having a low-, intermediate- or high-risk condition, i.e. occurrence of a time-sensitive diagnosis at discharge from hospital. Multivariate regression analyses using data on symptoms and symptom onset, clinical findings including ECG, previous medical history and Troponin T were carried out to develop models for identification of patients with low- respectively high-risk conditions. Developed models where then tested hold-out data set for internal validation and assessing their accuracy. RESULTS: Prediction models for risk-stratification based on variables mutual for both low- and high-risk prediction were developed. The variables included were: age, sex, previous medical history of kidney disease, atrial fibrillation or heart failure, Troponin T, ST-depression on ECG, paleness, pain debut during activity, constant pain, pain in right arm and pressuring pain quality. The high-risk model had an area under the receiving operating characteristic curve of 0.85 and the corresponding figure for the low-risk model was 0.78. CONCLUSIONS: Models based on readily available information in the EMS setting can identify high- and low-risk conditions with acceptable accuracy. A clinical decision support tool based on developed models may provide valuable clinical guidance and facilitate referral to less resource-intensive venues.
Wibring et al. (Mon,) conducted a cohort in Chest pain (n=2,578). Prehospital prediction models was evaluated on Identification of high-risk and low-risk conditions (occurrence of a time-sensitive diagnosis at discharge) (AUC 0.85 for high-risk model; AUC 0.78 for low-risk model). Prehospital prediction models based on readily available EMS variables identified high-risk chest pain conditions with an AUC of 0.85 and low-risk conditions with an AUC of 0.78.
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