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JOURNAL ARTICLE

Effectiveness of using the front door score to enhance the chest pain triage accuracy of emergency nurse triage decisions

Jonathan K M Ho, Lorna K P Suen
Journal of Cardiovascular Nursing 2013, 28 (6): E55-64
23416933

BACKGROUND: Nurses lack a standard tool to stratify the risk of chest pain in triage patients. The type of risk stratification may correspond to the type of acuity rating of the 5-level triage scale adopted by nurses for chest pain triage, based on the Front Door Score, simplified from the Thrombolysis in Myocardial Infarction Risk Score for unstable angina or non-ST-segment elevation myocardial infarction.

AIM: This study aimed to evaluate the ability of using the Front Door Score to enhance the accuracy of emergency nurse triage decisions for patients who present with chest pain.

DESIGN: A cross-sectional descriptive design was used.

METHODS: A convenience sample of 200 subjects was obtained from an emergency department in Hong Kong. Data were collected via a questionnaire. The final physician diagnoses were used as the gold standard in justifying the appropriateness of the risk stratification of chest pain. The agreement rates among the final physician diagnoses, Thrombolysis in Myocardial Infarction Risk Score for unstable angina or non-ST-segment elevation myocardial infarction, nurses using the triage scale, and nurses using the Front Door Score were computed using κ statistics.

RESULTS: A significant substantial agreement was observed between the final physician diagnoses and nurses using the Front Door Score. In comparison, the agreement between the final physician diagnoses and nurses using the triage scale was poor.

CONCLUSION: The chest pain triage reliability of nurses using the Front Door Score was found to be much more credible than that of nurses using the triage scale. A suggested conversion of the scales of Front Door Score was established.

CLINICAL IMPLICATIONS: The Front Door Score should be considered as a standard tool to enhance the chest pain triage accuracy of emergency nurse triage decisions.

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