Improving triage accuracy through a modified nurse-administered emergency department assessment of chest pain score on patients with chest pain at triage (EDACT): A prospective observational study

•The current nursing triage gestalt used in the emergency department, provided a higher level of sensitivity in detecting possible acute coronary syndromes.•However, the modified emergency department assessment of chest pain score provides a higher level of specificity and accuracy in correct identification of patients with acute coronary syndromes.•Application of the modified emergency department assessment of chest pain score, in conjunction with current nursing triage gestalt, has potential to provide a more structured approach to chest pain triage in the emergency department. Chest pain triage in our emergency department (ED) prioritize patients for consultation based on unstructured nursing gestalt. The Emergency Department Assessment of Chest Pain Score (EDACS) identifies patients at low-risk for major adverse cardiac events and may provide standardization for chest pain triage in ED. We conducted a prospective observational study, including adult patients with chief complaint of chest pain who were self-conveyed. We aimed to evaluate the overall diagnostic performance of a modified EDACS in triaging these patients. Data was collected over 6 weeks, with 284 patients included in the final analysis. Nursing gestalt had higher sensitivity (97.6%, 95% confidence interval [CI] 87.4% to 99.9% versus EDACS 45.2%, 95% CI 29.8% to 61.3%), while modified EDACS provided higher specificity (76.4%, 95% CI 70.6% to 81.6%, versus nursing gestalt 29.8%, 95% CI 24.1% to 35.9%). EDACS with electrocardiogram had significantly better area under the receiver operating characteristic curve statistic (0.712; 95% CI 0.631 to 0.793) than EDACS alone (0.608; 95% CI 0.528 to 0.689) and nursing gestalt (0.637; 95% CI 0.600 to 0.674) (p = 0.0324). Further studies should explore if modified EDACS, together with nursing gestalt, can improve triage accuracy for ED patients with chest pain.