Development and evaluation of the TRIGGER score to identify patients with acute coronary syndrome in the emergency department

Background/aims Acute coronary syndrome is a serious possible cause of chest pain, but detection rates at initial triage are low. This study evaluated the TRIGGER score as a tool for identifying patients with acute coronary syndrome who present to the emergency department with chest pain. Methods Data from 100 patients who presented to the emergency department with chest pain in February 2019 (before implementation of the TRIGGER score) were compared to 100 patients who presented in February 2020 (after implementation of the TRIGGER score). The proportion of patients with a final diagnosis of acute coronary syndrome was calculated and the predictive value of the TRIGGER score for acute coronary syndrome was evaluated. Results The majority of patients with a TRIGGER score of 9 or higher (actioning urgent referral) were found to have acute coronary syndrome or another cardiac condition. Overall, 50% of patients with a score of 10, 67% of patients with a score of 11 and 75% of patients with a score over 11 were found to have acute coronary syndrome. Overall, the TRIGGER score had 84.0% sensitivity and 81.7% specificity for acute coronary syndrome. The score was also associated with a decrease in average time to specialist review from 225 minutes to 112 minutes. Challenges associated with the tool included misclassification and increased workload. Conclusions The TRIGGER score is a useful tool for the rapid identification and referral of patients presenting with chest pain who have a high likelihood of acute coronary syndrome.