Druilhe Loïc, Creusier Lucie, Pasco Jérémy, Eloi Julie, Furet Virginie, Roupie Eric, Macrez Richard
Department of General Practice, University of Tours, Tours, France.
Caen University Hospital, Polyvalent Medicine Department, Caen, France.
Emerg Med Int. 2025 May 20;2025:6085679. doi: 10.1155/emmi/6085679. eCollection 2025.
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. 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. 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. 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.
胸痛是急诊科常见的主诉。尽管大多数患者被收入急诊科重症监护病房，但只有12%患有急性冠脉综合征。需要一个准确、有效的评分来改善分诊并避免不必要的转诊至急诊科重症监护病房。马尔堡心脏评分在基层医疗中已得到验证，可排除急性冠脉综合征，其实施快速且无需检查结果。本研究旨在评估马尔堡心脏评分在急诊科对胸痛患者进行分诊时是否有效。这项前瞻性、观察性、多中心研究于2018年7月15日至2019年5月31日在法国四家医院与分诊护士共同开展。主要终点是马尔堡心脏评分≤2排除急性冠脉综合征的阴性预测值。急性冠脉综合征的诊断采用病历数据结合主管医生的诊断。共纳入1045例患者。对于截断值≤2时，疑似急性冠脉综合征的阴性预测值为95.6%（95%可信区间[94.0 - 97.2]），曲线下面积为0.603（95%可信区间[0.521 - 0.685]）。有28例假阴性，其中两例是由于评分填写错误。本研究表明，马尔堡心脏评分是一种有效的工具，可将胸痛且马尔堡心脏评分<2的患者分诊至普通急诊科床位。这有可能优化急诊科分诊以防止急诊科重症监护病房过度负荷。
