Comparison between Emergency Severity Index plus Capnometer and Emergency Severity Index in the dyspneic patients with Chronic Heart Failure

Background: The Emergency Severity Index (ESI) may not recognize high-risk patients with heart failure (HF) efficiently.Aim: This study aimed to compare the diagnostic validity and mistriage rates of the ESI plus the Capnometer (Capno) and ESI alone among dyspneic patients with HF.Method: This quasi-experimental group (random assignment) study was conducted within April ۲۰۱۹-February ۲۰۲۰. Patients were randomly assigned to the ESI+Capno and ESI groups. Triage levels, resources used, disposition and door to an electrocardiogram, and physician visit were compared among patients admitted to the Cardiac Care Unit (CCU), the Cardiac Unit (CU), or discharged from the ED. Interobserver agreement (Kappa) was used to assess the reliability of the ESI.Results: In this study, ۶۵ HF patients were assigned to the ESI+Capno (n=۳۶) and ESI (n=۲۹) groups. The undertriage rates were ۰% and ۱۰% and the overtriage rates were ۱۰% and ۳۱% in the ESI+Capno and ESI groups, respectively. Sensitivity, specificity, and accuracy to recognize high-risk HF patients were ۱۰۰%, ۶۰%, and ۹۰% for the ESI+Capno group and ۶۲.۵%, ۴۲.۸۶%, and ۴۸.۳۶% for the ESI group.Implications for Practice: The addition of Capno to the ESI increased the validity of triage decisions to recognize high-risk HF patients, compared to the ESI alone. It is recommended that decisions regarding triage HF patients be made after that an End-tidal Co۲ is considered into the decision-making process.