The efficiency of the manchester triage system and the modified heart (HEAR) score in the management of patients who applied to the emergency department with chest pain

Introduction and Aim: In this study, we aimed to validate the effectiveness of the Manchester Triage System (MTS) and the HEAR score in the management of patients admitted to the emergency department with the complaint of chest pain. Materials and Methods: This prospective, observational study; conducted with the participation of 288 cases who applied to Sakarya University Training and Research Hospital Emergency Medicine Clinic between 05.10.2019-25.03.2020 with the complaint of chest pain. The data obtained within the scope of the study were collected in three stages by recording them on a pre-prepared patient evaluation form. For statistical analysis, IBM SPSS Statistics 22 New York Software was used and p <0.05 values were considered significant. Results: 54.2% of 288 patients included in our study were male and the mean age was 54.54±16.79. It was found that 79 (27.4%) of the patients were diagnosed with ACS and 78 (27.1%) of the patients had a MACE within six weeks. It was found that MTS was not useful in diagnosing ACS, but the HEAR score was useful (respectively; p = 0.171, p = 0.000). Manchester Triage System was not sufficient to predict the probability of having a MACE within six weeks (p=0,206), however, it was determined that the HEAR score predicts the probability of having a MACE within six weeks, with a sensitivity of 87.2% and a specificity of 64.3% at 4.5 threshold and with a sensitivity of 97.1% and a specificity of 46.3% at 3.5 threshold (p = 0.000). Conclusion: It is seen that MTS is not useful in diagnosing ACS in patients admitted to the emergency department with chest pain and in predicting the possibility of having a MACE within six weeks, on the other hand, the HEAR score is useful for both. However, larger series are needed to support this result. Keywords: Acute coronary syndrome, Chest pain, HEAR score, Manchester triage system, Major adverse cardiac event