Validation of a new risk score for nurse inter-hospital cardiologic transfer

Abstract

Because of the unequal distribution of invasive cardiology resources in France, need for inter-hospital transfer to tertiary centers is frequent, mainly supported by the Emergency Medical Service (SAMU). Inter-Hospital Nurse Transfers (IHNT) is a growing option to preserve medical resources, promoted by health policy. However, no dedicated IHNT framing protocol has been validated to date. Our objective was to retrospectively validate a new IHNT protocol (NEWS-GAP score) designed to select patients and estimate the risk of short term degradation during transport. We conducted a 2 years single center retrospective study with the SAMU 05, analyzing the outcomes of patients transferred by IHNT to tertiary high-volume cardiac cenrers with cathlab facilities. Adverse events during transportation were systematically collected. We investigated the predictive value of our NEWS-GAP score. Compared to GRACE and RSTP score, the NEWS-GAP is a dedicated IHNT two steps score. It combines a patient selection guideline allowing to consider IHNT, and a second step assessing patient transportability and risk of short term complications based on a well validated early warning score (NEWS2 score). Additional items complete this score, depending on distances and potential medical “rescue” from pre-hopsital healthcare provider. GRACE, RSTP and NEWS-GAP score were retrospectively evaluated for all patients. The study population group was composed of 140 patients. Acute coronary syndrome represented 85 % of the population. Ten adverse events were reported during transportation (5 desaturations, 3 chest pains, 1 non sustained rhythm disorder and 1 acute heart failure). None of those adverse events were life threatening, and all nurse-managed, except one requiring diversion toward the nearest ICU for medical management. The NEWS-GAP provides the best with AUC 0.97 on ROC curve analysis, and negative predictive value of 99.2 %, in addition to simplicity and versatility. GRACE score and RSTP had a negative predictive value of 0.95 and 0.93, respectively; ROC curve AUC for RSTP is 0.65 (Fig. 1). Nurse management for IHT of patients with acute coronary events, to preserve medical resource, is a safe and easy alternative to medical transport, for selected patients. The NEWS-GAP score seems suitable to support and supervise these specific inter-hospital transfer modalities.