Validation of the HAR Score for Prioritization of Patients Calling the Emergency Medical Service for Chest Pain by Emergency Call Dispatcher
ID: NCT06859021
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The lifetime prevalence of chest pain in the general population is 20-40%. The etiologies to be evoked from the outset of management are those of cardiovascular origin, such as acute coronary syndrome (ACS) and pulmonary embolism. ACS is responsible for almost 20% of deaths. Delay in treatment is a major prognostic factor, given the importance of coronary reperfusion. In France, one of the first contacts with the healthcare system is the medical regulation assistant (MRA) at the Centre 15. His or her role is to prioritize the call according to the identification of immediate signs of seriousness, and if necessary, to decide autonomously to send a rescue team before medical regulation. Depending on the reason for the call and any signs of seriousness, it prioritizes the call according to the expected response time. In line with current recommendations, all calls for chest pain should be answered by an emergency medical dispatcher (EMR) within 5 minutes. However, 60-90% of chest pain calls are not of cardiovascular origin. Their prioritization could therefore be re-qualified for longer response times. Given the frequency of this type of call, a more efficient MRA referral strategy is needed. To achieve this, decision-support tools would be essential. The performance of the HAR (History, Age and Risk Factors) score has been recently explored, derived from the HEART score, in a previous single-center prospective study in 2019. It stratifies the risk of a major cardiovascular event (MCE) into low (0 or 1 point), intermediate (2 or 3 points) or high (4, 5 or 6 points). Investigator's hypothesis is that the HAR score could be entrusted to MRA, to enable them to optimize the prioritization of patients calling with non-traumatic chest pain, by qualifying low-risk chest pain calls on the one hand, which could be prioritized in P2 SNP, and high-risk calls on the other, making it possible to anticipate the dispatch of an emergency service.
A follow-up call is made to the patient 30 days (+ 5 days) after inclusion to check for the occurrence of an Major Cardio Vascular Event.
Treatment Arms Description
patients who call for chest pain
- Patient of legal age (≥ 18 years)
- Calling Center 15 from 49, 72 or 37
- Expressing non-traumatic chest pain, even if this is not the main reason for seeking help.
- Treatment in departments other than 49, 72 and 37
- Poor understanding of the French language
- Non-affiliated or non-beneficiary of a social security scheme
- Person deprived of liberty by judicial or administrative decision
- Person under forced psychiatric care
- Person subject to a legal protection measure
- Person unable to express his/her non-opposition.
- Follow-up at Day 30 impossible for any reason
- Person having expressed his/her opposition to the collection of his/her data.
Primary Outcome Measures
- Number of major cardiovascular events — Time Frame: 30 days
Number of major cardiovascular events is measured by presence of Death from cardiological causes, Type 1 or 2 myocardial infarction, Percutaneous coronary intervention, Surgical coronary bypass surgery
View Secondary Outcome Measures (4)
- Performance of the HAR Score: Sensitivity, Specificity, and Comparison Between EMR and MRA — Time Frame: From Day 0 to Day 30
Sensitivity, specificity, likelihood ratios of the HAR score at different decision thresholds and the area under the ROC curve, as well as reclassification rates between the evaluation of the HAR score by the EMR (Emergency Medical Dispatcher) and the MRA (Medical Regulation Assistant)
- Comparaison between rescue resources decided and predicted by the HAR score — Time Frame: From Day 0 to Day 30
The proportion of rescue resources (SMUR - VSAV...) that would have been decided according to the HAR score (≥ 4 points) compared to the proportion of rescue resources actually decided upon
- Time delta between the end of the MRA's score suggesting the dispatch of equipment (HAR score ≥ 4 points) and the actual decision to dispatch equipment in the current situation. — Time Frame: From Day 0 to Day 30
- Area under the ROC curve and Delong-Delong test — Time Frame: From Day 0 to Day 30
This trial is recruiting at 3 study facilities worldwide. Click below to see if there is a clinic or hospital in your area:
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View Official Medical/Scientific Title
Validation of the HAR Score for Prioritization of Patients Calling the Emergency Medical Service for Chest Pain by Emergency Call Dispatcher : Reg-HAR Study