Smartphone-Based Screening for Cardiovascular Diseases: A Trend?

Abstract Cardiovascular diseases are the leading cause of death in the world. People living in vulnerable and poor places such as slums, rural areas and remote locations have difficulty in accessing medical care and diagnostic tests. In addition, given the COVID-19 pandemic, we are witnessing an increase in the use of telemedicine and non-invasive tools for monitoring vital signs. These questions motivate us to write this point of view and to describe some of the main innovations used for non-invasive screening of heart diseases. Smartphones are widely used by the population and are perfect tools for screening cardiovascular diseases. They are equipped with camera, flashlight, microphone, processor, and internet connection, which allow optical, electrical, and acoustic analysis of cardiovascular phenomena. Thus, when using signal processing and artificial intelligence approaches, smartphones may have predictive power for cardiovascular diseases. Here we present different smartphone approaches to analyze signals obtained from various methods including photoplethysmography, phonocardiograph, and electrocardiography to estimate heart rate, blood pressure, oxygen saturation (SpO2), heart murmurs and electrical conduction. Our objective is to present innovations in non-invasive diagnostics using the smartphone and to reflect on these trending approaches. These could help to improve health access and the screening of cardiovascular diseases for millions of people, particularly those living in needy areas.

Assessment of the patients' outcomes after implementation of South African triage scale in emergency department, Egypt / 中华创伤杂志(英文版)

PURPOSE@#Overcrowding in emergency department (ED) is a concerning global problem and has been identified as a national crisis in some countries. Several emergency sorting systems designed successfully in the world. Launched in 2004, a group of branches in South African triage scale (SATS) developed. The effectiveness of the case sorting system of SATS was evaluated to reduce the patient's length of stay (LOS) and mortality rate within the ED at Suez Canal University Hospital.@*METHODS@#The study was designed as an intervention study that included a systematic random sample of patients who presented to the ED in Suez Canal University Hospital. This study was implemented in three phases: pre-intervention phase, 115 patients were assessed by the traditional protocols; intervention phase, a structured training program was provided to the ED staff, including a workshop and lectures; and post-intervention phase, 230 patients were assessed by SATS. All the patients were retriaged 2 h later, calculating the LOS per patient and the mortality. Data was collected and entered using Microsoft Excel software. Collected data from the triage sheet were analyzed using the SPSS software program version 22.0.@*RESULTS@#The LOS in the ED was about 183.78 min before the intervention; while after the training program and the application of SATS, it was reduced to 51.39 min. About 15.7% of the patients died before the intervention; however, after the intervention the ratio decreased to 10.7% deaths.@*CONCLUSION@#SATS is better at assessing patients without missing important data. Additionally, it resulted in a decrease in the LOS and reduction in the mortality rate compared to the traditional protocol.

Clasificación de pacientes especiales según sus requerimientos en la atención estomatológica / Classification of specials patients according their dentist attention requirements

Introducción: El paciente de riesgo quirúrgico es aquel susceptible a un posible daño que amenaza al individuo que será sometido a una intervención quirúrgica. Este tipo de paciente es llamado"paciente especial", o que presenta deficiencias y existen además otros conceptos donde pudiera estar implícito. Este paciente no es claramente identificado y esto hace más complicado unificar criterios que permitan llevar a cabo un el tratamiento estomatológico sin causar daños colaterales. Objetivo: Elaborar una clasificación de pacientes especiales según sus requerimientos en la atención estomatológica. Métodos: Investigación cualitativa. Se realizó revisión bibliográfica y se tomaron en consideración investigaciones previas de la autora principal para la confección de la propuesta de clasificación. Para evaluar la misma se utilizó el método Delphi, lo cual permitió llegar a opiniones de consenso de los expertos, quienes valoraron la propuesta como: inadecuada, poco adecuada, adecuada, bastante adecuada y muy adecuada. Resultados: Se expone la clasificación de pacientes especiales según requerimientos durante la atención estomatológica. Incluyó a cinco grupos. El grupo I, nombrado de riesgo quirúrgico, se subdividió en cinco subgrupos. Los expertos consideraron la clasificación propuesta como Bastante Adecuada(2) y Muy Adecuada (12). Conclusiones: La clasificación propuesta facilita al estomatólogo una atención diferenciada al paciente especial, donde se hace adecuaciones en el paciente de riesgo quirúrgico teniendo en cuenta las características más importantes de las enfermedades de base. La clasificación propuesta fue catalogada como aceptada(AU)

Introduction: Numerous definitions exist where the patient of surgical risk can be incorporate keeping in mind her definition that is possible damage that she threatens the individual that will be subjected to a surgical intervention, such as patient special, with deficiencies among other but it has not been find a classification of patient of risk surgery. It cannot allow indentify those and it is difficult the dentist treatment without systemic complication. Objective: To elaborate a classification proposal of specials patients according dentist attention requirements. Methods: it was qualitative research. It was carried out exhaustive bibliographical revision and it took in consideration previous investigations carried out by the main author, with this consideration the classification proposal was made. To evaluate the proposal it used the method Delphi, which allowed arriving to opinions of the experts' consent. It took into consideration different variables: Inadequate, Not Appropriate, Appropriate, Quite Appropriate and Very Appropriate. Results: The classification is exposed of patient special according dentist attention requirements, it included to five groups and the group I was subdivided, called surgical risk, in five subgroups. 100 percent experts considered the classification like Quite Appropriate and Very Appropriate 2 in the first categories and 12 in the second one. Conclusions: The proposed classification facilitates to the dentist an attention to the differentiated special patient with emphasis in surgical risk patients keeping in mind the most important characteristics in the base illnesses. The proposed classification was classified as having accepted(AU)

Performance of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score among patients with COVID-19 pneumonia in an emergency department triage setting: a retrospective study

ABSTRACT BACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey. METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.

Categorización de las urgencias gineco-obstétricas en un hospital público de Chile / Categorization of the gyneco-obstetric emergencies in a public hospital in Chile

INTRODUCCIÓN: La red de atención de urgencia es fundamental en la salud de cualquier país. En Chile, los servicios de urgencia periódicamente están saturados por usuarios con patologías de carácter leve; lo mismo ocurre en las atenciones de urgencias gineco-obstétricas (UGO) en los centros de mediana y alta complejidad. OBJETIVO: Describir la categorización de las consultas de urgencias gineco-obstétricas en un hospital público de Chile, atendidas durante el año 2018. METODOLOGÍA: Estudio descriptivo y transversal que abarcó 3.077 consultas obtenidas de datos estadísticos anonimizados. RESULTADOS: De las UGO, el 58,3% fueron consultas obstétricas, el 36,9% ginecológicas y 4.8% neonatológicas; el 96% fueron consultantes mujeres; el 80,3% eran adultos y el 11,6% adolescentes; el 92,5% eran usuarios pertenecientes a la comuna de Penco; el mes más consultado fue mayo con 292 atenciones y el 71,5% de las consultas fueron atendidas en horario diurno. Los principales motivos de consulta obstétrica y ginecológica fueron el dolor y el sangramiento genital; en las urgencias neonatológicas, la ictericia fue el principal motivo de consulta. El diagnóstico más frecuente en las consultas obstétricas según clasificación CIE _10 fue la supervisión de embarazo normal, en las ginecológicas fue el dolor abdomino-pélvico y en las consultas neonatológicas, la ictericia; del total de consultas UGO un 91,1% fueron resueltas a nivel local. El 0,1% de las UGO fueron categorizadas como c1 y el 0,3% como c2, siendo la gran mayoría, consultas de baja complejidad. CONCLUSIONES: Existe un gran porcentaje de consultas de baja complejidad que sobrecargan el servicio de urgencia, afectando la calidad de la atención del hospital.

INTRODUCTION: the urgent care network is fundamental in the health of any country. In Chile, the emergency services are periodically saturated with users with mild pathologies; the same occurs in gynecological-obstetric emergency care (UGO) in more complex centers. OBJECTIVE: to describe the categorization of gynecological-obstetric emergency consultations in a public hospital in Chile, attended in 2018. METHODOLOGY: descriptive and cross-sectional study; covered 3,077 queries of anonymized statistical data. RESULTS: of the UGO, 58.3% were obstetric consultations, 36.9% gynecological and 4.8% neonatological; 96% were women; 80.3% were adults and 11.6% adolescents; 92.5% were from Penco; the month most consulted was may with 292 visits and 71.5% of the consultations were during daytime hours. The main reasons for obstetric and gynecological consultation were pain and genital bleeding; in neonatal emergencies, jaundice was the main reason for consultation. The most repeated diagnosis in obstetric consultations was the supervision of normal pregnancy; in gynecological cases, it was abdominal-pelvic pain and in neonatological consultations, jaundice; there was 91.1% local resolution. 0.1% of the UGO were categorized as c1 and 0.3% as c2, the vast majority being low complexity queries. CONCLUSIONS: there is a large percentage of low complexity consultations that overload the emergency service, affecting the quality of hospital care.

Escala de triagem odontológica para pacientes com necessidades especiais / Dental screening scale for patients with special needs

Objetivo: elaborar e testar uma Escala de Triagem Odontológica para Pacientes com Necessidades Especiais (PNEs). Métodos: a escala foi elaborada a partir da experiência clínica de um centro de referência para aten-dimento odontológico a PNEs e de evidências científicas. Foi construída utilizando cinco critérios principais: comportamento, necessidade e possibilidade de estabilização protetora, urgência odontológica (dor), núme-ro e complexidade de procedimentos odontológicos e local do atendimento (acessibilidade). O instrumento foi testado em 14 PNEs, que participaram de uma triagem no Centro de Especialidades Odontológicas (CEO) Jequitibá, na Faculdade de Odontologia da Universidade Federal de Pelotas (UFPel). Estudantes de gradua-ção a partir do oitavo semestre fizeram a aplicação, e o resultado da escala foi comparado ao parecer clínico realizado pelos pesquisadores experientes no atendimento a esses pacientes. Resultados: foi observada uma concordância em 85% dos casos. Conclusão: o instrumento apresentou desempenho comparável à avalia-ção de profissionais com expertise, e a escala pode ser um instrumento útil para ser empregado em serviços odontológicos que oferecem atendimento aos PNEs. A sua utilização em meio acadêmico também pode pro-porcionar o empoderamento dos critérios de avaliação pelos estudantes, proporcionando maior segurança em acolher, atender ou encaminhar esse público no seu futuro profissional. (AU)

Objective: to develop and test a dental screening scale to be used of patients with special needs (PSN). Method: the scale was developed based on the clinical experience of a reference center for dental care for PSN and scientific evidence. It was built using 5 main criteria: behavior, need and possibility of protective stabilization (PE), dental urgency (pain), number and complexity of dental procedures and place of care (accessibility). The instrument was tested on 14 PSN who participated in a screening at the Center for Dental Specialties (CEO) Jequitibá, Faculty of Dentistry, UFPEL. Undergraduate students from the eighth semester onwards applied and the result of the scale was compared to the clinical opinion carried out by experienced researchers in the care of these patients. Results: agreement was observed in 85% of cases. Conclusion: the instrument presented performance comparable to the evaluation of professionals with expertise and the scale can be a useful instrument to be used in dental services that offer care to PSN. Its use in academia can also provide the empowerment of assessment criteria by students, providing greater security in welcoming, serving or referring this audience in their professional future.

El triaje en pandemia: fundamentos éticos para la asignación de recursos de soporte vital avanzado en escenarios de escasez / Pandemic triage: ethical foundations for the allocation of advanced life support resources in scarcity scenario

Las pandemias y otras catástrofes de alto impacto sanitario azotan periódicamente a la humanidad, aumentando desproporcionadamente la demanda por atención en servicios de urgencia, unidades de cuidados intensivos y medios de soporte vital avanzado. Este desequilibrio obliga a una compleja toma de decisiones en que se deben asignar recursos proporcionalmente escasos en relación a una gran demanda. Así, los equipos clínicos asistenciales necesitan actuar bajo criterios consensuados, que orienten sus decisiones y alivien la pesada carga moral de seleccionar pacientes para terapias, en detrimento de otros. El triaje es una estrategia que permite establecer, bajo racionalidades propias a cada escenario, objetivos y criterios que faciliten la toma de decisiones complejas para el logro del mejor resultado. Estas estrategias deben considerar el marco de valores intangibles que apreciamos y que nos identifican cultural y socialmente, como son el respeto a la vida, la igualdad, la justicia y la libertad. Sin embargo, en escenarios excepcionales como el de la actual pandemia COVID-19, en que el sistema sanitario puede no dar abasto, deberán establecerse objetivos prioritarios, como salvar la mayor cantidad de vidas, del modo más humano, justo y eficiente posible. A la vez, deberán redefinirse jerarquías en los valores y principios clásicos de la práctica clínica cotidiana, adecuadas a la catástrofe sanitaria, bajo una ética propia de la salud pública, el mayor bien para la mayoría y el mejor cuidado de los que no pueden ser curados.

Pandemics and other global disasters regularly overwhelm humankind. These catastrophic events suddenly increase demand for health-care in emergency services, intensive care units, and for advanced life support devices. This imbalance requires complex decision-making in which scarce resources must be allocated in relation to high demand. Thus, health-care teams need to act under consensus criteria that guide their decisions and alleviate the heavy moral burden of selecting patients for therapies, excluding others. Triage is a strategy that allows to establish, under appropriate rationalities, objectives and criteria that facilitate complex decisions to achieve the best results. These strategies should consider the framework of intangible values that we appreciate and identify us culturally and socially, such as respect for life, equity, justice and freedom. However, in exceptional scenarios such as the current COVID-19 pandemic, where the health system may be overcome, priority goals should focus in order to save as many lives as possible and by mean the most humane, fair and efficient way possible. At the same time, hierarchies of classical values and principles of daily clinical practice should be redefined in an appropriate way to face this catastrophic scenario, under an ethics for public health, the greatest good for the most and the best care of those who cannot be cured.

Las simulaciones de pacientes politraumatizados mejoran el conocimiento y el criterio de aplicación de triaje en estudiantes de sexto año de la facultad de medicina de la Universidad Francisco Marroquín / Simulations of polytraumatized patients improve the knowledge and application criteria of triage in sixth-year students of the faculty of medicine of the Francisco Marroquín University

Introducción y objetivos: Las simulaciones han sido una estrategia que se ha desarrollado para prevenir los errores médicos ya que proporcionan un ambiente seguro para el aprendizaje, donde los errores no son fatales. Triaje se define como la clasificación de pacientes según la severidad de sus lesiones con el propósito de salvar la mayor cantidad de vidas con los recursos disponibles. El objetivo del estudio es determinar si las simulaciones de pacientes politraumatizados mejoran el conocimiento y criterio de aplicación de triaje. Métodos: Este fué un estudio descriptivo prospectivo donde se realizó un examen antes y al finalizar las simulaciones de pacientes politraumatizados. esultados: El puntaje promedio fue de 50.73 y 59.44 antes y después de la simulaciones espectivamente. El 53 % de los pacientes fueron sobreclasificados, el 40% fue clasificado correctamente y el 6% fueron subclasificados en el examen previo a las simulaciones, el 40% de los pacientes fue sobreclasificado y el 60% fue clasificado correctamente en el examen al finalizar las simulaciones. Discusión: Aunque se presentó un escenario con todos los recursos necesarios, los estudiantes analizaron los casos en base a la realidad de Guatemala, por lo que sobre clasificaron a los pacientes. Sin embargo, se evidenció una mejoría en el puntaje y en la correcta clasificación de los pacientes. (AU)

Introduction and objectives: Simulations have been developed as a strategy to prevent medical errors, because they provide a safe environment to learn from mistakes and the mistakes are not fatal. Triage is defined as the classification of patients according to the severity of their injuries in order to save as many lives with the available resources. The objective of the study is to determine if simulations of polytraumatized patients improve the knowledge and criteria of triage application. Methods: This was a prospective descriptive study where a test was performed before and at the end of the simulations of solytraumatized patients. Results: The average results were 50.73 and 59.44 before and after the simulations respectively. They overclassified 53% of the patients, 40% was correctly classified and 6% were subclassified in the pre-simulation test, in the test at the end of the simulations 40% were overclassified and 60% were correctly classified. Discussion: Although the scenario was presented with all the necessary resources, the students analyzed the cases based on the reality of Guatemala, so they had the tendency to over-classified the patients. However, there was an improvement in the score and in the correct classification of patients. (AU)

Riesgo de resangrado en hemorragia digestiva alta según la escala de Glasgow-Blatchford: herramienta de triaje / Upper gastrointestinal hemorrhage re-bleeding risk according to the Glasgow-Blatchford scale: a triage tool

Resumen Introducción: Con la escala de Glasgow-Blatchford (EG-B) se califica mediante datos clínicos, el riesgo de resangrado después de hemorragia del tubo digestivo alto (HTDA); y con las escalas de Forrest y Dagradi, mediante endoscopia. Objetivo: Evaluar la capacidad de la EG-B para identificar riesgo de resangrado a 30 días después de una HTDA; el estándar de oro de comparación fue la endoscopia. Método: Se analizaron 129 expedientes de pacientes con HTDA y endoscopia. Se cuantificaron las escalas de Glasgow-Blatchford, Forrest y Dagradi; se calculó sensibilidad, especificidad y área bajo la curva ROC (ABC-ROC) del riesgo de resangrado reportado por EG-B. Resultados: La EG-B identificó a 53 pacientes con riesgo bajo de resangrado (41.09 %) y 76 con riesgo alto (58.91 %). Con la endoscopia se identificó a 107 pacientes con hemorragia no variceal (82.94 %), 98 con riesgo bajo (89.9 %) y 11 con riesgo alto (10.09 %); además, 22 pacientes con hemorragia variceal (17.05 %), 12 con riesgo bajo (54.54 %) y 10 con riesgo alto (45.45 %). La EG-B mostró sensibilidad de 0.857, especificidad de 0.462 y ABC-ROC de 0.660. Conclusiones: La EG-B es sencilla, objetiva y útil para identificar riesgo de resangrado después de HTDA; se sugiere como herramienta de triaje en urgencias.

Abstract Introduction: The Glasgow-Blatchford scale (GBS) classifies the risk of re-bleeding after upper gastrointestinal bleeding (UGIB) using clinical data, whereas the Forrest and Dagradi scales do it by endoscopy. Objective: To assess GBS’s ability to identify re-bleeding risk within 30 days of an UGIB, using endoscopy as the gold standard for comparison. Method: 129 medical records of patients with UGIB and endoscopy were analyzed. The Glasgow-Blatchford, Forrest and Dagradi scales were quantified; sensitivity, specificity and area under the ROC curve (AUC-ROC) of GBS-reported re-bleeding risk were calculated. Results: GBS identified 53 patients with low re-bleeding risk (41.09 %) and 76 with high risk (58.91 %). Endoscopy identified 107 patients with non-variceal bleeding (82.94 %): 98 with low risk (89.9 %) and 11 with high risk (10.09 %); in addition, it identified 22 patients with variceal hemorrhage (17.05 %): 12 with low risk (54.54 %) and 10 with high risk (45.45 %). GBS showed a sensitivity of 0.857, specificity of 0.462 and an AUC-ROC of 0.660. Conclusions: GBS is simple, objective and useful to identify the risk of re-bleeding after UGIB; it is suggested as a triage tool in the emergency department.

Triage hospitalario. La clasificación de la atención según el nivel de urgencia, en los servicios de urgencias / Hospital triage. Classification of care according to level of urgency, at emergency departments

El triage hospitalario en los servicios de urgencias es un proceso de valoración clínica preliminar. Permite clasificar a los pacientes según su nivel de urgencia y no por orden de llegada. Prioriza la asistencia de los pacientes graves. Organiza la atención de acuerdo a la demanda, los recursos físicos y humanos disponibles. Debe incluir protocolos que definan la clasificación del nivel de urgencia, los tiempos de asistencia y reevaluación, las intervenciones que se pueden ejecutar en el sector y el registro de las actuaciones. La clasificación del nivel de urgencia se define mediante el triángulo de evaluación pediátrica, el problema principal, las constantes vitales y la consideración de modificadores o alertas. Aunque resulta imprescindible, su uso no está uinversalmente difundido(AU)

At emergency departments, triage is the process of initial clinical assessment. It allows for the classification of patients based on their level of emergency regardless of order of arrival. It prioritizes care for severe patients and organizes care according to the demand and available physical and human resources. The triage should include protocols that define classification of the level of urgency, necessary times for care and reassessment, interventions that may be performed in the area, and recording of the activities. The level of emergency is classified based on the triad of pediatric assessment, consisting of the main complaint, vital signs, and consideration of modifiers or alerts. Although essential, it is not universally used (AU).

Lung Ultrasound as a Triage Tool in an Emergency Setting during the Covid-19 Outbreak: comparison with CT Findings

Abstract Background Lung ultrasound (LUS) can detect interstitial alveolar changes confined to the subpleural region, like those described in Covid-19. Objetive To evaluate how LUS findings correlate with chest computed tomography (CT) in patients admitted to the emergency department (ED) with suspicion of Covid-19. Methods Cross-sectional study of 20 patients (median age 43 years; interquartile range, 37-63 years; 50% male). All patients underwent LUS and chest CT on the day of ED admission. Each hemithorax was divided into 6 segments with similar landmarks, and equivalent scores (sc) of lesion severity were defined for both methods. The number of affected segments on LUS (LUSseg) was divided into tertiles (0-1, 2-5, and ≥6), and compared with number of affected segments on CT (CTseg), LUSsc, CTsc, and percentage of affected lung parenchyma through visual analysis (CTvis). ANOVA or Kruskal-Wallis test for continuous variables, chi-square test for categorical variables, and receiver operating characteristic (ROC) curve analysis to define optimal cutoff points were performed. P<0.05 was considered statistically significant. Results Median LUSsc, CTsc, CTseg, and CTvis were significantly different between groups. A clear separation between groups was demonstrated; patients with <2 affected segments on LUS were defined as low risk. The ROC curve showed good discriminative power to predict ≥6 affected segments on CT, with an area under the curve (AUC) of 0.97 and 0.98 for >7 LUSsc and >3 LUSseg, respectively. Conclusion LUS findings correlate with chest CT, and can help identify patients with normal lung or minor pulmonary involvement secondary to Covid-19. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Os Escores HEART, TIMI e GRACE para Predição de Eventos Cardiovasculares Adversos Maiores no Período de 30 Dias na Era de Troponina I de Alta Sensibilidade / HEART, TIMI, and GRACE Scores for Prediction of 30-Day Major Adverse Cardiovascular Events in the Era of High-Sensitivity Troponin

Resumo Fundamento Múltiplos sistemas de pontuação têm sido elaborados para calcular o risco de eventos cardiovasculares adversos maiores (MACE) em pacientes com dor no peito. Não há dados que avaliem se o escore HEART tem um desempenho superior a TIMI e GRACE para a predição de MACE, especialmente na era de troponina I de alta sensibilidade e em uma população exclusivamente latino-americana. Objetivo Comparar o desempenho dos escores HEART, TIMI e GRACE para a predição de MACE em 30 dias de acompanhamento, em pacientes atendidos com dor no peito no departamento de emergência. Métodos Os escores HEART, TIMI e GRACE foram analisados em 519 pacientes com dor no peito no departamento de emergência. O desfecho primário foi a ocorrência de MACE no período de 30 dias. O desempenho do escore HEART foi comparado com o dos escores TIMI e GRACE utilizando o teste de DeLong, considerando estatisticamente significativos os valores de p de 0,05. Resultados Um total de 224 pacientes (43%) apresentaram MACE no período de 30 dias. A estatística C para os escores HEART, TIMI e GRACE foi de 0,937, 0,844 e 0,797 respectivamente (p < 0,0001). Uma pontuação de 3 ou menos no escore HEART apresentou uma sensibilidade de 99,5% e um valor preditivo negativo de 99% para classificar pacientes de baixo risco de maneira correta; ambos os valores foram mais elevados do que aqueles obtidos pelos outros escores. Conclusão O escore HEART, em um período de 30 dias, prediz eventos cardiovasculares, mais eficazmente, em comparação com os outros escores. Troponinas de alta sensibilidade mantêm a superioridade previamente demonstrada deste escore. Este escore oferece uma identificação mais precisa dos pacientes de baixo risco. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Multiple scoring systems have been designed to calculate the risk of major adverse cardiovascular events (MACE) in patients with chest pain. There is no data on whether the HEART score outperforms TIMI and GRACE in the prediction of MACE, especially in the era of high-sensitivity troponin assay and in an exclusively Latin-American population. Objective To compare the performance of the HEART, TIMI, and GRACE scores for predicting major cardiovascular events at 30 days of follow-up, in patients who consult for chest pain in the emergency department. Methods HEART, TIMI, and GRACE scores were analyzed in 519 patients with chest pain at the emergency department. The primary endpoint was the occurrence of MACE within 30 days. The performance of the HEART score was compared with the TIMI and GRACE scores using the DeLong test with p values of 0.05 considered statistically significant. Results A total of 224 patients (43%) had MACE at 30 days. The C statistic for the HEART, TIMI, and GRACE score was 0.937, 0.844, and 0.797 respectively (p < 0.0001). A HEART score of 3 or less had a sensitivity of 99.5% and a negative predictive value of 99% to classify low risk patients correctly; both values were higher than those obtained by the other scores. Conclusion The HEART score more effectively predicts cardiovascular events at 30 days of follow-up compared to the other scores. High-sensitivity troponins maintain this score's previously demonstrated superiority. This score offers more precise identification of low-risk patients. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)