{"id":650,"date":"2019-02-07T18:52:10","date_gmt":"2019-02-07T18:52:10","guid":{"rendered":"http:\/\/clinicalbiochemistry.net\/?page_id=650"},"modified":"2019-02-07T18:52:11","modified_gmt":"2019-02-07T18:52:11","slug":"modified-timi-score","status":"publish","type":"page","link":"http:\/\/clinicalbiochemistry.net\/?page_id=650","title":{"rendered":"Modified TIMI Score"},"content":{"rendered":"\n

Body, R., Carley, S., McDowell, G. <\/strong>& Mackway-Jones. K. (2009) \u2018Can a modified TIMI risk score help to guide patient disposition.\u2019 Emerg Med J<\/em>26 pp. 95-99. <\/p>\n\n\n\n

Background<\/strong>: The thrombolysis in myocardial infarction (TIMI) risk score has been shown to risk stratify patients with suspected acute coronary syndromes (ACS) effectively in the emergency department (ED) but cannot be used to guide patient disposition. We aimed to evaluate whether modifying the TIMI risk score to give greater weighting to ischaemic ECG changes and troponin elevations would enhance its risk stratification and thus potentially facilitate safe patient discharge after 12-h troponin testing.<\/p>\n\n\n\n

Methods:<\/strong>A prospective diagnostic cohort study was performed within the ED at Manchester Royal Infirmary, a university-affiliated teaching hospital with an annual ED census of approximately 145 000 patients. 804 patients who had presented to the ED with suspected cardiac chest pain were recruited. All patients underwent 12-htroponin T testing and were followed up by telephone and chart review after 30 days for the composite primary outcome of death, acute myocardial infarction (AMI) or urgent coronary revascularisation.\u00a0<\/p>\n\n\n\n

Results:<\/strong>The modified TIMI risk score outperformed the original (area under the receiver operator characteristic curve 0.87 versus 0.77, p,0.001). Using a cut-off of more than 2 points the score had a sensitivity of 96.4% for the prediction of 30-day events. The specificity of the score was only 51.0%, suggesting that in practice over 40% of patients would be ineligible for discharge even after troponin testing. <\/p>\n\n\n\n

Conclusions:<\/strong>Modifications to the TIMI risk score can improve its performance in the risk stratification of patients presenting to the ED with chest pain. However, a lack of specificity may still limit its use for guiding patient disposition after troponin testing<\/p>\n\n\nLink to Journal<\/span><\/a>","protected":false},"excerpt":{"rendered":"

Body, R., Carley, S., McDowell, G. & Mackway-Jones. K. (2009) \u2018Can a modified TIMI risk score help to guide patient disposition.\u2019 Emerg Med J26 pp. 95-99.  Background: The thrombolysis in myocardial infarction (TIMI) risk score has been shown to risk stratify patients with<\/p>\n","protected":false},"author":1,"featured_media":594,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"jetpack_post_was_ever_published":false,"_links_to":"","_links_to_target":""},"jetpack_shortlink":"https:\/\/wp.me\/P9tPlw-au","jetpack-related-posts":[{"id":549,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=549","url_meta":{"origin":650,"position":0},"title":"PhD Project: BEST Study","date":"January 11, 2019","format":false,"excerpt":"Expediting the confirmation of acute myocardial infarction with point of care troponin and heart fatty acid binding protein testing to facilitate early intervention in emergency department Cardiac troponin is the reference standard biomarker for the diagnosis of acute myocardial infarction (AMI). In the appropriate clinical context, the detection of a\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":654,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=654","url_meta":{"origin":650,"position":1},"title":"Does Troponin Cut-off Matter?","date":"February 7, 2019","format":false,"excerpt":"Body, R.,\u00a0McDowell, G., Carley, S., Ferguson, J. & Mackway-Jones, K. (2010) \u2018Diagnosing acute myocardial infarction with troponins: how low can you go?\u2019\u00a0Emerg Med J. 27 pp. 292-296. Background:Recent consensus guidelines state that acute myocardial infarction (AMI) may be diagnosed in the context of a troponin rise above the 99th percentile\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Tn-How-low-can-you-go-e1549807753211.png?fit=400%2C325&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":531,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=531","url_meta":{"origin":650,"position":2},"title":"Manchester Acute Coronary Syndrome Rule (MACS & T-MACS)","date":"January 19, 2019","format":false,"excerpt":"Clinical EvaluationClinical DataBiomarker Development and Validation Current diagnostic methods for acute coronary syndromes lack sensitivity and specificity at the time of presentation to the Emergency Department. The MACS and T-MACS rule has been developed using information available at the time of first presentation and the results from a single blood\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2017\/12\/Research-Papers-Pages-1.png?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":629,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=629","url_meta":{"origin":650,"position":3},"title":"Risk Factors and AMI","date":"February 7, 2019","format":false,"excerpt":"Body, R.,\u00a0McDowell, G.,Carley, S. & Mackway-Jones, K. (2008) \u2018Do risk factors for chronic coronary heart disease help diagnose acute myocardial infarction in the emergency department.\u2019\u00a0Resuscitation79 pp. 41-45.\u00a0 Background:Hypertension, hyperlipidaemia, diabetes mellitus, tobacco smoking and a family history of premature coronary artery disease are known to be risk factors for the\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Risk-factors-for-ED-diagnosis-e1549807935709.png?fit=400%2C313&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":641,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=641","url_meta":{"origin":650,"position":4},"title":"A FABP-ulous rule out strategy","date":"February 7, 2019","format":false,"excerpt":"Body, R.,\u00a0McDowell, G., Carley, S., Wibberley, C., Ferguson, J. & Mackway-Jones, K. (2011) \u2018A FABP-ulous rule out strategy? Heart fatty acid binding protein and troponin for rapid exclusion of acute myocardial infarction.\u2019\u00a0Resuscitation82 pp. 1041-1046.\u00a0 Objective:Many Emergency Departments (EDs) utilise \u2018triple marker\u2019 testing with CK-MB, myoglobin and troponin I (cTnI) to\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Quanti-HFABP-e1549807872944.png?fit=400%2C341&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":646,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=646","url_meta":{"origin":650,"position":5},"title":"Undetectable hs-cTnT","date":"February 7, 2019","format":false,"excerpt":"Body, R., Carley, S.,\u00a0McDowell, G., Jaffe, A.S., France, M., Cruickshank, K., Wibberley, C., Nuttall, M. & Mackway-Jones, K. (2011) \u2018Rapid exclusion of acute myocardial infarction in patients\u2019 with undetectable troponin using a high sensitivity assay.\u2019\u00a0J Am Coll Cardiol58 pp. 1332-1339. Objectives:This paper sought to evaluate whether high sensitivity troponin (hs-cTnT)\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/JACC-paper-e1549807840111.png?fit=400%2C268&resize=350%2C200","width":350,"height":200},"classes":[]}],"_links":{"self":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/650"}],"collection":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=650"}],"version-history":[{"count":3,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/650\/revisions"}],"predecessor-version":[{"id":671,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/650\/revisions\/671"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/media\/594"}],"wp:attachment":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=650"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}