Background 

The Emergency Severity Index (ESI) is a widely used tool to triage patients in emergency departments. The ESI tool is used to assess all complaints and has significant limitation for accurately triaging patients with suspected acute coronary syndrome (ACS).

Objective 

We evaluated the accuracy of ESI in predicting serious outcomes in suspected ACS and aimed to assess the incremental reclassification performance if ESI is supplemented with a clinically validated tool used to risk-stratify suspected ACS.

Methods 

We used existing data from an observational cohort study of patients with chest pain. We extracted ESI scores documented by triage nurses during routine medical care. Two independent reviewers adjudicated the primary outcome, incidence of 30-day major adverse cardiac events. We compared ESI with the well-established modified HEAR/T (patient History, Electrocardiogram, Age, Risk factors, but without Troponin) score.

Results 

Our sample included 750 patients (age, 59 ± 17 years; 43% female; 40% black). A total of 145 patients (19%) experienced major adverse cardiac event. The area under the receiver operating characteristic curve for ESI score for predicting major adverse cardiac event was 0.656, compared with 0.796 for the modified HEAR/T score. Using the modified HEAR/T score, 181 of the 391 false positives (46%) and 16 of the 19 false negatives (84%) assigned by ESI could be reclassified correctly.

Conclusion 

The ESI score is poorly associated with serious outcomes in patients with suspected ACS. Supplementing the ESI tool with input from other validated clinical tools can greatly improve the accuracy of triage in patients with suspected ACS.

中文翻译：

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疑似急性冠状动脉综合征患者的患者结局与初始紧急严重程度指数分类评分之间的关​​联。

背景 

在紧急情况严重程度指数（ESI）是一种广泛使用的工具来分流病人在急诊室。ESI 工具用于评估所有主诉，但在准确分类疑似急性冠状动脉综合征(ACS) 的患者方面存在重大局限性。

客观的 

我们评估了 ESI 在预测疑似 ACS 严重结果方面的准确性，并旨在评估如果 ESI 辅以用于对疑似 ACS 进行风险分层的临床验证工具，则增量重新分类性能。

方法 

我们使用了一项针对胸痛患者的观察性队列研究的现有数据。我们提取了在常规医疗护理期间由分流护士记录的 ESI 分数。两名独立审查员裁定主要结果，即 30 天主要不良心脏事件的发生率。我们将 ESI 与完善的改良 HEAR/T（患者病史、心电图、年龄、危险因素，但不含肌钙蛋白）评分进行了比较。

结果 

我们的样本包括 750 名患者（年龄，59 ± 17 岁；43% 女性；40% 黑人）。共有 145 名患者 (19%) 经历了严重的心脏不良事件。用于预测主要不良心脏事件的 ESI 评分的受试者工作特征曲线下面积为 0.656，而改良 HEAR/T 评分为 0.796。使用修改后的 HEAR/T 分数，ESI 分配的 391 个假阳性中的 181 个 (46%) 和 19 个假阴性中的 16 个 (84%) 可以被正确地重新分类。

结论 

ESI 评分与疑似 ACS 患者的严重结果相关性较差。用来自其他经过验证的临床工具的输入补充 ESI 工具可以大大提高疑似 ACS 患者分流的准确性。