The Comparison of the Diagnostic Value Between the Modified Heart Score and The Emergency Severity Index Triage in Elderly Patients with Chest Pain

Background: Diagnostic triage using the Emergency Severity Index (ESI) in elderly patients with cardiac complaints is associated with significant triage errors. Objective: This study aimed to compare the diagnostic value of the Modified HEART Score, the overall Clinical Classification, and the Emergency Severity Index in identifying clinical deterioration in patients presenting with chest pain. Methods: This cross-sectional descriptive-analytical study was conducted in ۲۰۲۳ on ۱۷۸ patients. Patients presenting with chest pain were triaged using two methods: the Modified HEART Score and the ESI. The outcomes of ward admission and length of stay were compared with the triage level using Fisher's exact test. The diagnostic accuracy and triage error for the Modified HEART Score and ESI were calculated based on admission outcomes to the Cardiac Care Unit (CCU) and low-risk outcomes, including admission to the internal cardiology ward or discharge from the emergency department. Data were analyzed using SPSS software version ۲۱. A p-value of less than ۰.۰۵ was considered statistically significant. Results: For the Modified HEART Score, the total triage error based on the ward admission outcome was ۱۲.۹%, comprising ۱.۷% under-triage and ۱۱.۲% over-triage. The total triage error for the Emergency Severity Index was ۴۱%, comprising ۳.۴% under-triage and ۳۷.۶% over-triage. There was no significant difference in under-triage error between the two methods, regardless of ward admission (p=۰.۲۶). However, a significant difference was found in over-triage error between the two methods (p<۰.۰۰۱). The sensitivity and specificity of the Modified Cardiac Triage Score were ۹۱.۸۹% and ۸۵.۸۲%, respectively. At the same time, for the ESI triage, they were ۸۳.۷۸% and ۴۳.۹۱%, respectively. Conclusion: The findings suggest that Cognitive-Analytic Therapy can be an effective therapeutic approach for enhancing psychological functioning and interpersonal skills among individuals with ASPD.

کلیدواژه ها:

Triage ، Chest Pain ، Cardiac Disease ، Ischemic Heart Disease