ArticleThe Journal of cardiovascular nursing
The Association Between Patient Outcomes and the Initial Emergency Severity Index Triage Score in Patients With Suspected Acute Coronary Syndrome.
Article in The Journal of cardiovascular nursing. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed, 8 citations in OpenAlex.
- The impact of a disparity-reduction intervention on outcomes of patients with acute coronary syndrome in the emergency department: a clinical trial.International journal for equity in health · 2025Trial
- Outcomes of 72-hour emergency department return visits requiring hospital admission in older adults: a nationally representative analysis.BMC geriatrics · 2026Article
- Development and Validation of an Artificial Intelligence Electrocardiogram Recommendation System in the Emergency Department.Journal of personalized medicine · 2022Article
- Exploring the complex interactions of baseline patient factors to improve nursing triage of acute coronary syndrome.Research in nursing & health · 2020Article
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
Abstract
backgroundThe 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).
objectiveWe 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.
methodsWe 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.
resultsOur 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.
conclusionThe 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.
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