Razavi Journal of Medicine

Razavi Journal of Medicine

The Comparison of the Diagnostic Value Between the Modified Heart Score and The Emergency Severity Index Triage in Elderly Patients with Chest Pain

Articles in Press

Document Type : Original Article

Authors
Hosein Ajamzibad 1
Amir Mirhaghi 2
Mohammad Reza Aghilipour 3
Atefeh ShirinZadeh Feizabadi 4
rasoul gharaei 5
Zahra Zandi 6
1 Department of Aging Health, Social Development & Health Promotion Research Center, School of Nursing, Gonabad University of Medical Sciences, Gonabad, Iran
2 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
3 Department of Cardiac Surgery, Razavi Hospital, Imam Reza International University, Mashhad, Iran
4 Department of Anesthesiology, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
5 M.Sc in Emergency Nursing, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
6 Department of Cardiovascular Disease, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
10.30483/rjm.2026.254706.1470
Abstract
Background: Diagnostic triage using the Emergency Severity Index (ESI) in elderly patients with cardiac complaints is associated with significant triage errors.
 
Objective: 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.
 
Methods: 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.
 
Results: 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.
 
Conclusion: The findings suggest that Cognitive-Analytic Therapy can be an effective therapeutic approach for enhancing psychological functioning and interpersonal skills among individuals with ASPD.
Keywords
Triage
Chest Pain
Cardiac Disease
Ischemic Heart Disease

Acknowledgements: The authors would like to express their gratitude to the Emergency Department staff in Allameh Behlool Gonabadi Hospital, and Razavi Hospital, for their invaluable cooperation and support throughout the study.

 

Availability of data and materials: The data that support the findings of this study are available from the corresponding author upon reasonable request.

 

Conflicts of interests: The authors declare no conflict of interest.

 

Consent for publication: Not applicable.

 

Ethics approval and consent to participate: The Gonabad University of Medical Sciences ethics committee approved the study protocol under IR.GMU.REC.1402.075, which complies with the Declaration of Helsinki. Written informed consent was secured from all participants.

 

Financial disclosure: No financial support was received for this study.

 

Author contributions: H.A.: Contributed to the conception of the work, revising the draft, approving the final version of the manuscript, and agreeing on all aspects of the work; A. M. and A.Sh.F.: contributed to the critical revision, and approval of the final version of the manuscript; M. R. A. and R.G.: Contributed to the conception and design of the study, critical revision, and approval of the manuscript's final version; Z.Z.: Contributed to the conception and design of the study, drafting of the manuscript and critical revision, and approval of final version.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Razavi Journal of Medicine

Articles in Press, Accepted Manuscript
Available Online from 15 March 2026