Clinical Gestalt and TIMI Risk Score in Predicting Major Cardiac Event in Patients with Chest Pain at Emergency Department

Year 2024, , 207 - 215, 30.09.2024

Damla Anbarlı Metin , Sedat Yanturalı , Zeyneo Ertürk , Emre Şancı

https://doi.org/10.46871/eams.1518638

Abstract

Background
Chest pain is one of the leading complaints causing Emergency Department (ED) admissions. Approximately 25% of all ED visits are due to acute coronary syndrome (ACS). The TIMI risk score is a commonly and easily used bedside risk scoring method.

Objective
In this prospective observational study, the TIMI risk score and clinical gestalt were compared in terms of detecting a major adverse cardiac event (MACE) in patients presenting with chest pain at ED.

Methods
A total of 351 patients were evaluated by experienced clinicians in respect of the TIMI risk score (1-7 points) and clinical gestalt (in terms of low-, medium- and high-risk major adverse cardiac event). The primary outcome was a major adverse cardiac event within 14 days of presentation at ED.

Results
A major adverse cardiac event occurred within 14 days in 87 (24.7%) of 351 patients. The sensitivity of clinical gestalt was 93.10% (85.59%-97.43%), and the specificity of the TIMI risk score was 75.89% (71.33%-81.84%). The TIMI risk score and clinical gestalt were found to have similar results in detecting a major cardiac event (AUC: 0.75; AUC: 0.72).

Conclusions
The results of the present study showed that TIMI scoring and clinical gestalt detect any major adverse cardiac event at similar rates in patients presenting with chest pain at ED.

Keywords

TIMI score, clinical gestalt, chest pain, major adverse cardiac event

Acil Serviste Göğüs Ağrısı ile Başvuran Hastalarda Klinik Gestalt ve TIMI Risk Skorunun Major Kardiyak Olayı Öngörmedeki yeri

Abstract

Giriş
Göğüs ağrısı, Acil Servis (AS) başvurularına neden olan önemli şikayetlerden biridir. Göğüs ağrısı nedeniyle olan AS başvurularının yaklaşık %25'i akut koroner sendrom (AKS) nedeniyle gerçekleşmektedir. TIMI risk skoru, yaygın ve kolayca kullanılan bir yatak başı risk skorlama yöntemidir.
Bu prospektif gözlemsel çalışmada, TIMI risk skoru ve klinik gestaltın , Acil Servis'e göğüs ağrısı ile başvuran hastalarda major kardiyak olay (MACE) tespitinde karşılaştırıldı.

Materyal- Metot
Toplamda 351 hasta, deneyimli klinisyenler tarafından TIMI risk skoru (1-7 puan) ve klinik değerlendirme (major kardiyak olay açısından düşük, orta ve yüksek riskli ) açısından değerlendirildi. Birincil sonuç, AS başvurusundan sonraki 14 gün içinde major kardiyak olaydı.

Bulgular
351 hastanın 87'sinde (%24,7) 14 gün içinde major kardiyak olay meydana geldi. Klinik gestaltın duyarlılığı %93,10 (85,59%-97,43%) ve TIMI risk skorunun özgüllüğü %75,89 (71,33%-81,84%) olarak bulundu. TIMI risk skoru ve klinik gestaltın, major kardiyak olayı tespit etmede benzer sonuçlar verdiği tespit edildi (AUC: 0,75; AUC: 0,72).
Sonuç
Bu çalışmanın sonuçları, Acil Servis'e göğüs ağrısı ile başvuran hastalarda TIMI puanlaması ve klinik değerlendirmenin herhangi bir major kardiyak olayı tespit etmede benzer oranlarda olduğunu göstermiştir.

Keywords

klinik gestalt, TIMI skoru, major kardiyak olay, göğüs ağrısı

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