Key result
Modified FRENCH scale incorporating cardiovascular risk factors improves ACS diagnostic performance over standard ECG alone.
Why the study?
Triage scales for chest pain patients in the emergency department have varying sensitivity and specificity, and combining ECG with cardiovascular risk factors may improve diagnostic performance.
Does a modified FRENCH scale combining ECG and cardiovascular risk factors improve diagnostic performance compared to the standard ECG-based FRENCH scale in patients presenting with chest pain to the emergency department?
Observational (n=505)
No
Does a modified FRENCH scale combining ECG and cardiovascular risk factors improve diagnostic performance compared to the standard ECG-based FRENCH scale in patients presenting with chest pain to the emergency department?
Combining ECG with accurately collected cardiovascular risk factors by physicians improves the diagnostic performance of chest pain triage in the emergency department.
Answers are grounded in this paper and cite their sources.
May enhance ECG-based chest pain triage accuracy with physician-collected CVRF; leaves open whether it improves outcomes or reduces overcrowding in practice.
BACKGROUND: The triage of patients presenting with chest pain on admission to the emergency department uses scales based on patient clinical presentation or an electrocardiogram (ECG). These scales have different sensitivity and specificity. Although a good sensitivity allows for the prompt identification of high-risk patients, specificity prevent ED overcrowding. Moreover, ECG at triage avoids missing ST elevation myocardial infarction, which requires urgent revascularization. Our study therefore aimed to investigate whether a scale combining ECG and cardiovascular risk factors (CVRF) improves the diagnostic performance of ED chest pain triage scale. METHODS AND RESULTS: In this prospective single-center observational study involving 505 patients, the standard ECG-based FRENCH scale was compared to a scale combining the ECG-based FRENCH scale and the patients CVRF. The new scale was called the "modified" FRENCH. The accuracy of patient CVRF collection was evaluated by comparing the results of triage nurses and ED physicians. Compared with the standard FRENCH scale, the modified FRENCH scale had an increased sensitivity (61% versus 75%) but a decrease in specificity (76% versus 64%) resulting in a similar diagnostic performance. Using CVRF collected by the ED physicians, the modified FRENCH scale had a sensitivity of 87% and a specificity of 56% with a significant improvement in his diagnostic performance compared with standard FRENCH scales. This improvement can be explained by an accurate collection of the CVRF by physicians compared with nurses, as suggested by the weak to moderate correlation between their respective data collection. CONCLUSION: In conclusion, combining ECG and accurately collected cardiovascular risks factor improves the diagnostic performance of the ECG based chest pain triage in the ED. TRIAL REGISTRATION: Trial registration number: NCT03913767 .
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Casarin et al. (2022) conducted an observational in Chest pain (n=505). Modified FRENCH scale (combining ECG and physician-collected cardiovascular risk factors) vs. Standard FRENCH scale (ECG-based) was evaluated on Diagnostic performance (Area under the ROC curve) for identifying acute coronary syndrome (p=<0.001). The physician-collected modified FRENCH scale, combining ECG and cardiovascular risk factors, improved diagnostic performance for acute coronary syndrome compared to the standard ECG-based scale.
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