Predictive score for acute coronary syndrome during a call to the dispatch center for chest pain: SCARE score.

Guerineau Audrey, Rozelle Clement, Sevestre Elodie, Narcisse Sophie, Laribi Said, Giovannetti Olivier

Resumen


Introduction: Acute Coronary Syndromes (ACS) are the leading cause of death in the world. It is essential to identify any ACS as early as possible during medical assessment to provide an adapted therapy. Currently no ACS predictive score is available for use in dispatch centers. The goal is to establish such a score, confirm its efficacy and check its accuracy. Secondary outcome consists in determining whether there is a correlation between the occurrence of an ACS and the physician’s intuition.

Material and method: Our prospective, observational and monocentric study was conducted from 01/01/2016 to 12/31/2016 at a French dispatch center, including any call for chest pain. Our population was randomly divided into two subgroups. In the derivation sample, univariate and multivariate analyses identified independent factors associated with ACS in assessment, and allowed the creation of a predictive score. In the validation sample, the discrimination was assessed by the area under the curve (AUC) and the calibration by the Hosmer-Lemeshow test.

Results:  1,367 patients were included in this study. Seven variables were significantly associated with the diagnosis of ACS in assessment : male gender, age, smoking, typicality of the pain, its inaugural character, diaphoresis and physician’s intuition. The SCARE score, thus created, is calculated from these seven elements. The AUC of the multivariate regression model is 0.81 and the Hosmer-Lemeshow "p" is 0.74 in the validation sample. The physicians’ intuition has a Negative Predictive Value of 95%.

Conclusion: We were able to establish an ACS predictive score, usable for assessment of chest pain, the SCARE score, which has good results in internal validation. This score allows risk stratifying of ACS, using the physician’s intuition which is an innovative and interesting element.

Keywords: assessment, chest pain, ACS predictive score, physician’s intuition.


Palabras Clave


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