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 efficiently.Aim: The goal of this work was to compare the diagnostic validity and mistriage rates of the ESI plus the Capnometer (Capno) and ESI among dyspneic patients with heart failure (HF).Methods: This study was a quasi-experimental group (random assignment) conducted from April 2019 to February 2020. Patients randomly assigned to the ESI+Capno or ESI groups. Triage levels, resources used, disposition and door to ECG 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 reliability of the ESI.Results: Sixty-five HF patients were assigned to the ESI+Capno (n=36) and ESI (n=29) groups. The under-triage rates were 0% and 10%, the over-triage rates were 10% and 31% in the ESI+Capno and ESI groups, respectively. Sensitivity, specificity, accuracy to recognize high-risk HF patients were 100%, 60%, 90% and 62.5%, 42.86%, 48.36% for ESI+Capno and ESI groups, respectively.Implication for Practice: Addition of Capnometer to the ESI increases validity of triage decisions to recognize high-risk HF patients compared to ESI alone. It is recommended that decision to triage HF patients be made after an End-tidal Co2 is considered into decision-making process.