Evaluating the Efficacy of the Marburg Heart Score to Triage Patients Presenting With Chest Pain in an Emergency Department: A Prospective, Multicenter, Observational Study.

Abstract

Objective: Chest pain is a common complaint in emergency departments. Although most patients are admitted to emergency department intensive care, only 12% have acute coronary syndrome. An accurate, efficient score is needed to improve triage and prevent unnecessary referrals to emergency department intensive care. The Marburg Heart Score, validated to rule out acute coronary syndrome in primary care, is quick to administer and does not require test results. This study aims to assess whether the Marburg Heart Score is effective in a triage setting for patients presenting with chest pain in emergency departments. Method: This prospective, observational, multicenter study was conducted with triage nurses in four hospitals in France between July 15, 2018, and May 31, 2019. The primary endpoint was the negative predictive value of the Marburg Heart Score ≤ 2 for ruling out acute coronary syndrome. Acute coronary syndrome diagnosis was made using medical record data combined with a diagnosis from the physician in charge. Results: A total of 1045 patients were included. For a cutoff score of ≤ 2, the negative predictive value for suspected acute coronary syndrome was 95.6% (95% CI [94.0-97.2]) and the area under the curve was 0.603 (95% CI [0.521-0.685]). There were 28 false negatives, two of which were due to the score being completed incorrectly. Conclusion: This study reveals that the Marburg Heart Score is an efficient tool to direct patients presenting with chest pain and MHS < 2 to a conventional ED bed. This could potentially optimize triage in the emergency department to prevent overloading the emergency department intensive care.