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. 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. 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 number: NCT03913767 .

中文翻译：

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提高急诊科胸痛患者分诊量表的性能：结合心血管危险因素和心电图

急诊科就诊时出现胸痛的患者分类使用基于患者临床表现或心电图 (ECG) 的量表。这些量表具有不同的敏感性和特异性。虽然良好的敏感性可以迅速识别高危患者，但特异性可以防止 ED 过度拥挤。此外，分诊时的心电图可避免遗漏 ST 段抬高心肌梗死，后者需要紧急血运重建。因此，我们的研究旨在调查结合心电图和心血管危险因素 (CVRF) 的量表是否能提高 ED 胸痛分诊量表的诊断性能。在这项涉及 505 名患者的前瞻性单中心观察性研究中，将基于 ECG 的标准 FRENCH 量表与基于 ECG 的 FRENCH 量表和患者 CVRF 相结合的量表进行了比较。新的音阶被称为“修改后的”法语。通过比较分诊护士和 ED 医生的结果来评估患者 CVRF 收集的准确性。与标准 FRENCH 量表相比，改良的 FRENCH 量表具有更高的敏感性（61% 对 75%），但特异性降低（76% 对 64%），从而导致相似的诊断性能。使用 ED 医生收集的 CVRF，与标准 FRENCH 量表相比，改良的 FRENCH 量表具有 87% 的敏感性和 56% 的特异性，其诊断性能显着提高。与护士相比，医生对 CVRF 的准确收集可以解释这种改进，正如他们各自数据收集之间的弱到中度相关性所表明的那样。综上所述，结合心电图和准确收集的心血管危险因素提高了急诊科基于心电图的胸痛分诊的诊断性能。试用注册号：NCT03913767。