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Analysis of institutional authors

López Barbeito, BeatrizAuthorSanchez, MCorresponding AuthorBragulat, EAuthorJimenez, SAuthorColl-Vinent, BAuthorOrtega, MAuthorMiro, OAuthor

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May 5, 2014
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Validation of a triage flowchart to rule out acute coronary syndrome

Publicated to:Emergency Medicine Journal. 28 (10): 841-846 - 2011-10-01 28(10), DOI: 10.1136/emj.2010.096602

Authors: Lopez, Beatriz; Sanchez, Miquel; Bragulat, Ernest; Jimenez, Sonia; Coll-Vinent, Blanca; Ortega, Mar; Gomez-Angelats, Elisenda; Miro, Oscar

Affiliations

Hosp Clin Barcelona, Emergency Dept, E-08036 Barcelona, Catalonia, Spain - Author
Hospital Clinic Barcelona - Author
IDIBAPS, Barcelona, Spain - Author

Abstract

To validate a triage flowchart to rule out acute coronary syndrome (ACS) in chest pain patients attending the emergency department (ED).An observational cohort study of consecutive patients. In all cases, a previously derived five-step triage flowchart (age ? 40 years, absence of diabetes, not previously known coronary artery disease, non-oppressive and non-retrosternal pain) was applied. Patients meeting all five discriminators were grouped as 'five-step triage non-ACS', the rest as 'five-step triage ACS'. The same strategy was used with a four-step model (without age ? 40 years). After ED study and 1-month follow-up, patients were definitively classified as 'true ACS' or 'true non-ACS'. Validity indexes and receiver operating characteristics curves were calculated.4231 patients were included: 918 (21.7%) were 'true ACS', 3303 (78.1%) 'true non-ACS'; 10 (0.2%) were lost to follow-up. The five-step triage flowchart classified 4000 (94.8%) as 'triage ACS' and 221 (5.2%) as 'triage non-ACS'; none of the latter was 'true ACS'. The four-step model classified 3194 (75.6%) as 'triage ACS' and 1027 (24.4%) as 'triage non-ACS'. A 'true ACS' was seen in 26 patients from the latter group. Accordingly, five-step triage flowchart specificity and positive predictive value (PPV) to rule out ACS were 100% (95% CI 100% to 100%). For the four-step model specificity and PPV were 97% (95% CI 96% to 98%).The five-step triage flowchart identifies chest pain patients without an ACS. However, only 5% of these patients meet these five criteria. A simpler model allows greater patient inclusion but a higher risk of misclassification of true ACS.

Keywords

Acute coronary syndromeAdultAgedChest painCohortCohort studiesCombinationDecision treesDischargeEfficacyEmergency service, hospitalFemaleHumansMaleMiddle agedPredictive value of testsProspective studiesReproducibility of resultsRiskRoc curveSafetySensitivity and specificityTherapyTriage

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Emergency Medicine Journal due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2011, it was in position 10/24, thus managing to position itself as a Q2 (Segundo Cuartil), in the category Emergency Medicine. Notably, the journal is positioned en el Cuartil Q2 para la agencia Scopus (SJR) en la categoría Emergency Medicine.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 1.36, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-17, the following number of citations:

  • WoS: 7
  • Scopus: 6
  • Europe PMC: 2
  • Google Scholar: 17

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-17:

  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 28 (PlumX).

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: London.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: Last Author (Miró Andreu, Òscar).

the author responsible for correspondence tasks has been Sánchez Sánchez, Miguel.