• Stephanie O Frisch, Ziad Faramand, Brandi Leverknight, Christian Martin-Gill, Susan M Sereika, Ervin Sejdić, Marilyn Hravnak, Clifton W Callaway, and Salah Al-Zaiti.
• Stephanie O. Frisch, MSN, RN, CEN Department of Acute & Tertiary Care Nursing, University of Pittsburgh; and University of Pittsburgh Medical Center, Pennsylvania. Ziad Faramand, MD Department of Acute & Tertiary Care Nursing, University of Pittsburgh, Pennsylvania. Brandi Leverknight, NRP Department of Emergency Medicine, University of Pittsburgh, Pennsylvania. Christian Martin-Gill, MD, MPH Department of Emergency Medicine, University of Pittsburgh; and University of Pittsburgh Medical Center, Pennsylvania. Susan M. Sereika, PhD Department of Center for Research and Evaluation, School of Nursing, University of Pittsburgh, Pennsylvania. Ervin Sejdić, PhD Department of Electrical & Computer Engineering, University of Pittsburgh, Pennsylvania. Marilyn Hravnak, PhD, CRNP, RN Department of Acute & Tertiary Care Nursing, University of Pittsburgh; and University of Pittsburgh Medical Center, Pennsylvania. Clifton W. Callaway, MD, PhD Department of Emergency Medicine, University of Pittsburgh; and University of Pittsburgh Medical Center, Pennsylvania. Salah Al-Zaiti, PhD, CRNP, RN Assistant Professor, Department of Acute & Tertiary Care Nursing, and Assistant Professor, Department of Emergency Medicine, University of Pittsburgh, Pennsylvania.
• J Cardiovasc Nurs. 2020 Nov 1; 35 (6): 550-557.

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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