Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 3 2026 07 01 The Comparison of the Diagnostic Value Between the Modified Heart Score and The Emergency Severity Index Triage in Elderly Patients with Chest Pain 1 12 118623 10.30483/rjm.2026.254706.1470 EN Hosein Ajamzibad Department of Aging Health, Social Development & Health Promotion Research Center, School of Nursing, Gonabad University of Medical Sciences, Gonabad, Iran Amir Mirhaghi Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran; AND, Prehospital Emergency Department, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran Mohammad Reza Aghilipour Department of Cardiac Surgery, Razavi Hospital, Imam Reza International University, Mashhad, Iran Atefeh ShirinZadeh Feizabadi Department of Anesthesiology, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran Rasoul Gharaei M.Sc in Emergency Nursing, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Zahra Zandi Department of Cardiovascular Disease, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 0000-0002-1357-7605 Journal Article 2025 06 28 <strong>Background:</strong> Diagnostic triage using the Emergency Severity Index (ESI) in elderly patients with cardiac complaints is associated with significant triage errors.<br> <br><strong>Objective: </strong>This study aimed to compare the diagnostic value of the Modified HEART Score, the overall Clinical Classification, and the Emergency Severity Index in identifying clinical deterioration in patients presenting with chest pain.<br> <br><strong>Methods: </strong>This cross-sectional descriptive-analytical study was conducted in 2023 on 178 patients. Patients presenting with chest pain were triaged using two methods: the Modified HEART Score and the ESI. The outcomes of ward admission and length of stay were compared with the triage level using Fisher's exact test. The diagnostic accuracy and triage error for the Modified HEART Score and ESI were calculated based on admission outcomes to the Cardiac Care Unit (CCU) and low-risk outcomes, including admission to the internal cardiology ward or discharge from the emergency department. Data were analyzed using SPSS software version 21. A p-value of less than 0.05 was considered statistically significant.<br> <br><strong>Results:</strong> For the Modified HEART Score, the total triage error based on the ward admission outcome was 12.9%, comprising 1.7% under-triage and 11.2% over-triage. The total triage error for the Emergency Severity Index was 41%, comprising 3.4% under-triage and 37.6% over-triage. There was no significant difference in under-triage error between the two methods, regardless of ward admission (p=0.26). However, a significant difference was found in over-triage error between the two methods (p<0.001). The sensitivity and specificity of the Modified Cardiac Triage Score were 91.89% and 85.82%, respectively. At the same time, for the ESI triage, they were 83.78% and 43.91%, respectively.<br> <br><strong>Conclusion:</strong> The findings suggest that Cognitive-Analytic Therapy can be an effective therapeutic approach for enhancing psychological functioning and interpersonal skills among individuals with ASPD. https://journal.razavihospital.ir/article_118623_b46e4d83eb0c080e114a32ee1f842b7d.pdf