Interrater agreement of the HEART score history component: A chart review study
Alec J Pawlukiewicz1, Matthew R Geringer2, W Tyler Davis1
1Department of Emergency Medicine San Antonio Uniformed Services Health Education Consortium San Antonio Texas USA.
Insights
Physician agreement on the history component of the HEART score was fair between emergency medicine and internal medicine attendings. Emergency medicine physicians assigned higher scores when disagreements occurred, impacting patient risk assessment.
Area of Science:
- Cardiology
- Medical Education
- Clinical Risk Assessment
Background:
- The HEART score (History, ECG, Age, Risk factors, Troponin) is used to assess the risk of major adverse cardiac events in patients with chest pain.
- Interrater reliability is crucial for consistent application of clinical decision rules.
Purpose of the Study:
- To evaluate the interrater reliability of the history component of the HEART score between emergency medicine (EM) and internal medicine (IM) physicians.
- To identify potential discrepancies in risk assessment based on physician specialty.
Main Methods:
- Retrospective analysis of 60 patient encounters with chest pain.
- Four physicians (EM attending, EM resident, IM attending, IM resident) independently scored the history component of the HEART score.
- Interrater agreement was measured using kappa coefficients and percent agreement.
Main Results:
- The kappa coefficient between EM and IM attending physicians was 0.33, indicating fair agreement.
- Agreement between EM attending and resident physicians was substantial, but fair to moderate between other pairs.
- EM attending physicians assigned significantly higher HEART scores compared to IM attending physicians in cases of disagreement.
Conclusions:
- There is fair agreement in the HEART score's history component between EM and IM attending physicians.
- Discrepancies in scoring, particularly higher scores by EM physicians, may influence patient management and risk stratification.
Study Objectives:
This study investigated the interrater reliability of the history component of the HEART (history, electrocardiogram, age, risk, troponin) score between physicians in emergency medicine (EM) and internal medicine (IM) at 1 tertiary-care center.
Methods:
We conducted a retrospective, secondary analysis of 60 encounters selected randomly from a database of 417 patients with chest pain presenting from January to June 2016 to an urban tertiary-care center. A total of 4 raters (1 EM attending, 1 EM resident, 1 IM attending, and 1 IM resident) scored the previously abstracted history data from these encounters.The primary outcome was the interrater agreement of HEART score history components, as measured by kappa coefficient, between EM and IM attending physicians. Secondary outcomes included the agreement between attending and resident physicians, overall agreement, pairwise percent agreement, and differences in scores assigned.
Results:
The kappa value for the EM attending physician and IM attending physician was 0.33 with 55% agreement. Interrater agreement of the other pairs was substantial between EM attending and resident but was otherwise fair to moderate. Percent agreement between the other pairs ranged from 48.3% to 80%. There was a significant difference in scores assigned and the subgroup in which there was disagreement between the raters demonstrated significantly higher scores by the EM attending and resident when compared to the IM attending.
Conclusion:
This study demonstrates fair agreement between EM and IM attending physicians in the history component of the HEART score with significantly higher scores by the EM attending physician in cases of disagreement at 1 tertiary-care center.
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