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      Inter-rater Reliability of the HEART Score

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          Abstract

          Background

          The HEART score is a risk stratification tool for suspected acute coronary syndrome and contains several subjective components. A single previous study found good inter-rater reliability. Our objective was to assess the inter-rater reliability of the HEART score in an external prospective cohort.

          Methods

          We prospectively collected paired, independent physician ratings of the HEART score for patients > 20 years of age presenting to the emergency department with chest pain for which an ECG and troponin were ordered. Two emergency physicians independently provided HEART scores for each unique patient. The primary outcome, the HEART score, was dichotomized by low risk (0–3) vs non- low risk (4–10). Additional outcomes included the HEART score across the entire scale (0–10) and subcomponents of the HEART score (e.g., history, electrocardiogram, risk factors; score of 0–2 for each). We calculated kappa statistics and percent agreement for all outcomes.

          Results

          We collected paired physician HEART score ratings on 311 patients from October 2017 to April 2018. The mean HEART score was 3.5 (SD 1.9). About half (49.2%) of our patients had a HEART score of ≤ 3, and 50.8% had a HEART score > 3. The kappa score for “low risk” (HEART ≤ 3) was 0.68 (95%CI: 0.60 – 0.77). There was 84.2% agreement between physicians on this variable.

          Conclusions

          Our study demonstrates there is substantial inter-rater reliability among emergency department physicians in identifying patients at low risk of acute coronary syndrome using the HEART score.

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          Author and article information

          Journal
          9418450
          20159
          Acad Emerg Med
          Acad Emerg Med
          Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
          1069-6563
          1553-2712
          24 January 2019
          28 December 2018
          May 2019
          01 May 2020
          : 26
          : 5
          : 552-555
          Affiliations
          [1 ]Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health and Sciences University, Portland OR
          Author notes
          Corresponding Author: Colin A. Gershon, MS, MPH, gershon@ 123456ohsu.edu , Phone: 503-494-1193, Fax: 503-494-4640, Address: Mail Code CR114, 3181 SW Sam Jackson Park Rd, Portland, OR 97239
          Article
          PMC6517079 PMC6517079 6517079 nihpa997453
          10.1111/acem.13665
          6517079
          30428149
          Categories
          Article

          kappa, chest pain, inter-rater reliability, HEART score

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