Discrepancy between clinician and research assistant in TIMI score calculation (TRIAGED CPU)

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Risk Stratification

Background:

• The Thrombolysis in Myocardial Infarction (TIMI) risk score is used to stratify patients with potential acute coronary syndromes (ACS).
• Previous studies often utilized trained research investigators to determine TIMI risk scores, not frontline ED providers.
• The impact of real-world ED pressures on TIMI score accuracy is not well understood.

Purpose of the Study:

• To compare TIMI risk scores calculated by emergency department (ED) providers with those determined by trained research investigators.
• To assess factors contributing to discrepancies in TIMI risk scores within a busy ED environment.

Main Methods:

• A prospective observational cohort study involving 501 adult patients in an ED chest pain unit (CPU).
• TIMI risk scores were obtained from both ED providers and a dedicated research team.
• Analysis included provider type, patient gender, and specific TIMI elements to identify sources of score variation.

Main Results:

• A significant percentage of TIMI risk scores (29.3%) differed between ED providers and research investigators.
• While most score differences were minor, 12% of TIMI risk scores varied by two or more points.
• Discrepancies were observed even in the low-risk patient population.

Conclusions:

• TIMI risk scores determined by ED providers in a busy ED setting frequently differ from those calculated by research investigators.
• The pressures and workflow of a typical ED may influence the accuracy of TIMI risk score application.
• These findings highlight potential challenges in relying solely on ED provider-generated TIMI scores for ACS risk stratification.