Carlos Romero-Olóriz, María José Luque-Hernández, Cristina López-López, Auxiliadora Caballero-García, Juan Antonio Péculo Carrasco, Miguel Ángel Armengol de La Hoz
Objective: To assess the diagnostic performance of the Emergency Coordination Center (CCUE) in identifying priority one or emergent cases among calls reporting nontraumatic chest pain.
Methods: This retrospective diagnostic performance study (2020-2024) analyzed a total of 248,116 calls categorized as nontraumatic chest pain, of which 97,905 included a clinical diagnosis. The assigned priority level was compared with the clinical diagnosis established by the out-of-hospital medical team, which served as the reference standard. Diagnostic performance metrics were calculated according to sociodemographic, territorial, and methodological variables. Uni- and multivariate analyses were conducted to identify factors associated with under- and overtriage.
Results: Undertriage occurred in 7.1% of cases and overtriage in 77.4%. Overall accuracy rate was 48.1%; sensitivity rate, 84.7%; and specificity rate, 40.6%. The positive predictive value was 22.6%, and the negative predictive value was 92.9%. Structured triage (GTTA23) showed lower sensitivity (78.9% vs 91.0%; P .001) but higher specificity (44.2% vs 31.6%; P .001), with a trend toward lower undertriage (6.6% vs 10.7%; P = .180) and higher overtriage (82.6% vs 61.8%; P .001) vs direct assignment. Interprovincial differences were low to moderate. In multivariate analysis, undertriage was associated with older age, home care, and nighttime calls, while female sex was protective. Overtriage was more likely among women, in public settings, and when coordination time was shorter.
Conclusions: The diagnostic performance of the CCUE for nontraumatic chest pain shows adequate sensitivity but low specificity, with acceptable undertriage and high overtriage. Structured triage improves the balance between safety and efficacy, although differences persist according to sex, age, and care setting.
目的：评估急诊协调中心（CCUE）在识别非创伤性胸痛呼叫中的优先病例或紧急病例方面的诊断表现。方法：这项回顾性诊断表现研究（2020-2024）分析了248,116例被归类为非创伤性胸痛的呼叫，其中97905例包括临床诊断。将分配的优先级与院外医疗队制定的临床诊断进行比较，作为参考标准。根据社会人口学、地域和方法变量计算诊断性能指标。进行了单因素和多因素分析，以确定与分流不足和过度相关的因素。结果：分诊不足占7.1%，分诊过多占77.4%。总体准确率为48.1%；敏感性为84.7%；特异性为40.6%。阳性预测值为22.6%，阴性预测值为92.9%。结构化分类（GTTA23）的敏感性较低(78.9% vs 91.0%；0.001)，但特异性更高(44.2% vs 31.6%；001)，分诊不足的趋势较低（6.6%对10.7%;P = 0.180），分诊过度的趋势较高（82.6%对61.8%;P = 0.180）。001) vs直接分配。省际差异低至中等。在多变量分析中，分类不足与年龄较大，家庭护理和夜间电话有关，而女性则具有保护作用。过度分类在女性、公共场合和协调时间较短的情况下更有可能发生。结论：CCUE对非外伤性胸痛的诊断具有足够的敏感性，但特异性较低，可接受的分流不足和过度分流。尽管根据性别、年龄和护理环境存在差异，但结构化分诊改善了安全性和有效性之间的平衡。
{"title":"Diagnostic performance of telephone triage for nontraumatic chest pain in the emergency coordination center: a population-based study in Andalusia.","authors":"Carlos Romero-Olóriz, María José Luque-Hernández, Cristina López-López, Auxiliadora Caballero-García, Juan Antonio Péculo Carrasco, Miguel Ángel Armengol de La Hoz","doi":"10.55633/s3me/101.2025","DOIUrl":"https://doi.org/10.55633/s3me/101.2025","url":null,"abstract":"<p><strong>Objective: </strong>To assess the diagnostic performance of the Emergency Coordination Center (CCUE) in identifying priority one or emergent cases among calls reporting nontraumatic chest pain.</p><p><strong>Methods: </strong>This retrospective diagnostic performance study (2020-2024) analyzed a total of 248,116 calls categorized as nontraumatic chest pain, of which 97,905 included a clinical diagnosis. The assigned priority level was compared with the clinical diagnosis established by the out-of-hospital medical team, which served as the reference standard. Diagnostic performance metrics were calculated according to sociodemographic, territorial, and methodological variables. Uni- and multivariate analyses were conducted to identify factors associated with under- and overtriage.</p><p><strong>Results: </strong>Undertriage occurred in 7.1% of cases and overtriage in 77.4%. Overall accuracy rate was 48.1%; sensitivity rate, 84.7%; and specificity rate, 40.6%. The positive predictive value was 22.6%, and the negative predictive value was 92.9%. Structured triage (GTTA23) showed lower sensitivity (78.9% vs 91.0%; P .001) but higher specificity (44.2% vs 31.6%; P .001), with a trend toward lower undertriage (6.6% vs 10.7%; P = .180) and higher overtriage (82.6% vs 61.8%; P .001) vs direct assignment. Interprovincial differences were low to moderate. In multivariate analysis, undertriage was associated with older age, home care, and nighttime calls, while female sex was protective. Overtriage was more likely among women, in public settings, and when coordination time was shorter.</p><p><strong>Conclusions: </strong>The diagnostic performance of the CCUE for nontraumatic chest pain shows adequate sensitivity but low specificity, with acceptable undertriage and high overtriage. Structured triage improves the balance between safety and efficacy, although differences persist according to sex, age, and care setting.</p>","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 6","pages":"433-441"},"PeriodicalIF":6.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alejandro Martín-Quirós, Milagros Jaen Cañadas, Paula Miralles Atencia, Víctor Gómez Carrillo, Laura Ávila Huertas, Francisco Miralles Linares
{"title":"Simulation of an AI-assisted workflow for emergency department triage: a comparative efficiency study.","authors":"Alejandro Martín-Quirós, Milagros Jaen Cañadas, Paula Miralles Atencia, Víctor Gómez Carrillo, Laura Ávila Huertas, Francisco Miralles Linares","doi":"10.55633/s3me/086.2025","DOIUrl":"https://doi.org/10.55633/s3me/086.2025","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 6","pages":"476-478"},"PeriodicalIF":6.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The role of artificial intelligence in interpreting radiological images in emergency departments.","authors":"Raúl López Izquierdo","doi":"10.55633/s3me/090.2025","DOIUrl":"https://doi.org/10.55633/s3me/090.2025","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 6","pages":"403-404"},"PeriodicalIF":6.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Home hospitalization from the emergency department: benefitis and remaining challenges.","authors":"José Manuel Fandiño Orgeira","doi":"10.55633/s3me/103.2025","DOIUrl":"https://doi.org/10.55633/s3me/103.2025","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 6","pages":"401-402"},"PeriodicalIF":6.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rafael Perelló, Cristobal Montilla, Sara Anaya, August Supervía, Alejandra Losada, Jordi Puiguriguer, Bartolomé Verd, Xavier Durán, Marta Torrens, Gabriel Vallecillo
{"title":"Clinical and epidemiological characteristics of patients with intentional self-poisoning.","authors":"Rafael Perelló, Cristobal Montilla, Sara Anaya, August Supervía, Alejandra Losada, Jordi Puiguriguer, Bartolomé Verd, Xavier Durán, Marta Torrens, Gabriel Vallecillo","doi":"10.55633/s3me/085.2025","DOIUrl":"https://doi.org/10.55633/s3me/085.2025","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 6","pages":"478-480"},"PeriodicalIF":6.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The difficult art of telephone triage: a middle ground between safety and efficacy.","authors":"Beatriz López Barbeito","doi":"10.55633/s3me/100.2025","DOIUrl":"https://doi.org/10.55633/s3me/100.2025","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 6","pages":"409-410"},"PeriodicalIF":6.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A la sombra de la urgencia.","authors":"F Javier Montero-Pérez","doi":"10.55633/s3me/083.2025","DOIUrl":"https://doi.org/10.55633/s3me/083.2025","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 5","pages":"389-390"},"PeriodicalIF":6.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Crowding, boarding, outlying, and other risky practices best avoided.","authors":"Josep M Mòdol Deltell, Javier Santesmases Ejarque","doi":"10.55633/s3me/079.2025","DOIUrl":"10.55633/s3me/079.2025","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 5","pages":"332-334"},"PeriodicalIF":6.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Semisynthetic cannabinoids: the intoxication ahead.","authors":"Miguel Galicia Paredes","doi":"10.55633/s3me/012.2025","DOIUrl":"https://doi.org/10.55633/s3me/012.2025","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 5","pages":"387-388"},"PeriodicalIF":6.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The importance of measuring the intensity of care provided by emergency nursing.","authors":"Montserrat Amigó Tadín","doi":"10.55633/s3me/075.2025","DOIUrl":"https://doi.org/10.55633/s3me/075.2025","url":null,"abstract":"","PeriodicalId":93987,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"37 5","pages":"321-322"},"PeriodicalIF":6.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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