Comparison of Triage Models of Suspected ACS Patients: A Case Study of the Far Eastern Memorial Hospital

  • Ray F. LinEmail author
  • Chieh Lee
  • Kuang-Chau Tsai
Conference paper
Part of the Advances in Intelligent Systems and Computing book series (AISC, volume 818)


This study aimed at evaluating four existing models, comprising he Zarich’s model [1], the flowchart model [2, 3], and the Heart Broken Index (HBI) model [4], for triaging potential acute coronary syndrome (ACS) patients who presented at the emergency department. The 793 clinical cases, randomly selected from 7,962 clinical cases that applied the HBI in the ED of the Far Eastern Memorial Hospital in Taiwan, were used for the model testing. The results showed that although the chest-pain and HBI models had high sensitivity (both 99.24%), they had very low specificity (3.93% and 4.08%), whereas the Zarch’s and flowchart models had relatively higher specificity (14.98% and 17.25%), but they had lower sensitivity (96.97% and 93.18%). To increase specificity and maintain high sensitivity while triaging suspected ACS patients, future research can focus on using systematic methods to develop more effective ACS triage models.


Acute coronary syndrome Emergency department Decision making Triage 


  1. 1.
    Zarich SW, Sachdeva R, Fishman R, Werdmann MJ, Parniawski M, Bernstein L, Dilella M (2004) Effectiveness of a multidisciplinary quality improvement initiative in reducing door-to-balloon times in primary angioplasty. J Interv Cardiol 17(4):191–195CrossRefGoogle Scholar
  2. 2.
    Sánchez M, López B, Bragulat E, Gómez-Angelats E, Jiménez S, Ortega M, Coll-Vinent B, Alonso JR, Queralt C, Miró Ò (2007) Triage flowchart to rule out acute coronary syndrome. Am J Emerg Med 25(8):865–872CrossRefGoogle Scholar
  3. 3.
    López B, Sánchez M, Bragulat E, Jiménez S, Coll-Vinent B, Ortega M, Gómez-Angelats E, Miró Ò (2010) Validation of a triage flowchart to rule out acute coronary syndrome. Emerg Med J 28:841–846CrossRefGoogle Scholar
  4. 4.
    Hsu J-C, Chen K-C, Cheng I-N, Li A-H (2011) Using heart broken index to improve the diagnostic accuracy of patient with STEMI and shorten door-to-balloon time on emergency department. Paper presented at the American Heart Association 2011 Scientific Sessions, Orlando, FloridaGoogle Scholar
  5. 5.
    Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE, Ettinger SM, Fesmire FM, Ganiats TG, Jneid H, Lincoff AM (2011) 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 57(19):e215–e367CrossRefGoogle Scholar
  6. 6.
    Hess EP, Brison RJ, Perry JJ, Calder LA, Thiruganasambandamoorthy V, Agarwal D, Sadosty AT, Silvilotti MLA, Jaffe AS, Montori VM (2012) Development of a clinical prediction rule for 30-day cardiac events in emergency department patients with chest pain and possible acute coronary syndrome. Ann Emerg Med 59(2):115–125CrossRefGoogle Scholar
  7. 7.
    Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, Griffith JL, Selker HP (2000) Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 342(16):1163–1170CrossRefGoogle Scholar
  8. 8.
    Rosenfeld AG, Knight EP, Steffen A, Burke L, Daya M, DeVon HA (2015) Symptom clusters in patients presenting to the emergency department with possible acute coronary syndrome differ by sex, age, and discharge diagnosis. Heart Lung J Acute Crit Care 44(5):368–375CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Industrial Engineering and ManagementYuan Ze UniversityTaoyuanTaiwan
  2. 2.Department of EmergencyFar Eastern Memorial HospitalNew Taipei CityTaiwan

Personalised recommendations