Evaluation of the Marburg Heart Score and INTERCHEST score compared to current telephone triage for chest pain in out-of-hours primary care,Netherlands Heart Journal

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Evaluation of the Marburg Heart Score and INTERCHEST score compared to current telephone triage for chest pain in out-of-hours primary care
Netherlands Heart Journal ( IF 1.7 ) Pub Date : 2022-12-29 , DOI: 10.1007/s12471-022-01745-0
A Manten ₁ , L De Clercq ₁ , R P Rietveld ₂ , W A M Lucassen ₁ , E P Moll van Charante _{1,

3} , R E Harskamp ₁

Affiliation

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.

中文翻译：

马尔堡心脏评分和 INTERCHEST 评分与非工作时间初级保健中胸痛的当前电话分诊相比的评估

介绍

胸痛是紧急初级保健中电话分诊的常见且具有挑战性的症状。最初为诊断目的而开发的现有胸痛特异性风险评分可能优于当前的电话分类协议。

方法

这项研究涉及一个回顾性、观察性的连续患者队列，这些患者在荷兰一家大型非工作时间初级保健机构接受胸痛评估。我们评估了马尔堡心脏评分 (MHS) 和 INTERCHEST 评分作为独立分流工具的性能，并将它们与当前的决策支持工具荷兰分流标准 (NTS) 进行了比较。感兴趣的结果是：以主要事件作为参考标准的优化阈值的 C 统计、校准和诊断准确性。重大事件是在初次接触后 6 周内发生的全因死亡率和心血管和非心血管紧急基础病症的综合。

结果

我们纳入了 1433 名患者，其中 57.6% 为女性，中位年龄为 55.0 岁。主要事件发生率为 16.4%（n  = 235），其中急性冠脉综合征占 6.8%（n  = 98）。对于预测重大事件，MHS 和 INTERCHEST 评分的 C 统计量分别为 0.74（95% 置信区间：0.70–0.77）和 0.76 (0.73–0.80)。相比之下，NTS 的 C 统计量为 0.66 (0.62–0.69)。都有适当的校准。与 NTS 相比，这两个分数（阈值 ≥ 2）都减少了转诊数量（假阳性率较低）并保持了相同的安全性。