The Association Between Patient Outcomes and the Initial Emergency Severity Index Triage Score in Patients with Suspected Acute Coronary Syndrome.

Background: The Emergency Severity Index (ESI) is a widely used tool to triage patients in Emergency Departments. The ESI tool is employed 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 to assess the incremental re-classification 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 chest pain patients. 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 (MACE). We compared ESI to 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 MACE. The area under the receiver operating characteristic curve for ESI score for predicting MACE was 0.656, compared to 0.796 for the modified HEAR/T score. Using the modified HEAR/T score, 181 out of the 391 (46%) false positives and 16 out of the 19 (84%) false negatives 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.