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

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.