Key result
INTERCHEST and Marburg Heart scores outperform current telephone triage for predicting major events in chest pain.
Why the study?
Chest pain is a challenging symptom for telephone triage in urgent primary care, and existing chest-pain-specific risk scores may outperform current telephone triage protocols.
Do the Marburg Heart Score and INTERCHEST score improve diagnostic accuracy for major events compared to the Netherlands Triage Standard in patients with chest pain in out-of-hours primary care?
Cohort (n=1,433)
No
Do the Marburg Heart Score and INTERCHEST score improve diagnostic accuracy for major events compared to the Netherlands Triage Standard in patients with chest pain in out-of-hours primary care?
Effect estimate: C-statistic 0.76 for INTERCHEST and 0.74 for MHS (95% CI 0.73-0.80)
The Marburg Heart Score and INTERCHEST score outperformed the current Netherlands Triage Standard for predicting major events in out-of-hours primary care chest pain triage, reducing unnecessary referrals without compromising safety.
MHS and INTERCHEST may reduce unnecessary referrals in out-of-hours chest pain triage; leaves open prospective safety and implementation.
INTRODUCTION: Chest pain is a common and challenging symptom for telephone triage in urgent primary care. Existing chest-pain-specific risk scores originally developed for diagnostic purposes may outperform current telephone triage protocols. METHODS: This study involved a retrospective, observational cohort of consecutive patients evaluated for chest pain at a large-scale out-of-hours primary care facility in the Netherlands. We evaluated the performance of the Marburg Heart Score (MHS) and INTERCHEST score as stand-alone triage tools and compared them with the current decision support tool, the Netherlands Triage Standard (NTS). The outcomes of interest were: C‑statistics, calibration and diagnostic accuracy for optimised thresholds with major events as the reference standard. Major events are a composite of all-cause mortality and both cardiovascular and non-cardiovascular urgent underlying conditions occurring within 6 weeks of initial contact. RESULTS: We included 1433 patients, 57.6% women, with a median age of 55.0 years. Major events occurred in 16.4% (n = 235), of which acute coronary syndrome accounted for 6.8% (n = 98). For predicting major events, C‑statistics for the MHS and INTERCHEST score were 0.74 (95% confidence interval: 0.70-0.77) and 0.76 (0.73-0.80), respectively. In comparison, the NTS had a C-statistic of 0.66 (0.62-0.69). All had appropriate calibration. Both scores (at threshold ≥ 2) reduced the number of referrals (with lower false-positive rates) and maintained equal safety compared with the NTS. CONCLUSION: Diagnostic risk stratification scores for chest pain may also improve telephone triage for major events in out-of-hours primary care, by reducing the number of unnecessary referrals without compromising triage safety. Further validation is warranted.
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Manten et al. (2022) conducted a cohort in Chest pain (n=1,433). Marburg Heart Score and INTERCHEST score vs. Netherlands Triage Standard (NTS) was evaluated on Major events (composite of all-cause mortality and urgent cardiovascular and non-cardiovascular conditions within 6 weeks) (C-statistic 0.76 for INTERCHEST and 0.74 for MHS, 95% CI 0.73-0.80). The INTERCHEST and Marburg Heart scores outperformed the current telephone triage protocol for predicting major events in chest pain patients, yielding C-statistics of 0.76 and 0.74 versus 0.66, respectively.
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