title: Discrepancy between clinician and research assistant in TIMI score calculation (TRIAGED CPU).
abstract: BACKGROUND
  Several studies have attempted to demonstrate that the Thrombolysis in Myocardial Infarction (TIMI) risk score has the ability to risk stratify emergency department (ED) patients with potential acute coronary syndromes (ACS). Most of the studies we reviewed relied on trained research investigators to determine TIMI risk scores rather than ED providers functioning in their normal work capacity. We assessed whether TIMI risk scores obtained by ED providers in the setting of a busy ED differed from those obtained by trained research investigators.
  
  
  METHODS
  This was an ED-based prospective observational cohort study comparing TIMI scores obtained by 49 ED providers admitting patients to an ED chest pain unit (CPU) to scores generated by a team of trained research investigators. We examined provider type, patient gender, and TIMI elements for their effects on TIMI risk score discrepancy.
  
  
  RESULTS
  Of the 501 adult patients enrolled in the study, 29.3% of TIMI risk scores determined by ED providers and trained research investigators were generated using identical TIMI risk score variables. In our low-risk population the majority of TIMI risk score differences were small; however, 12% of TIMI risk scores differed by two or more points.
  
  
  CONCLUSIONS
  TIMI risk scores determined by ED providers in the setting of a busy ED frequently differ from scores generated by trained research investigators who complete them while not under the same pressure of an ED provider.
authors: Lakeland HealthCare, Department of Emergency Medicine, St. Joseph MI, Department of Emergency Medicine, Saint Joseph, Michigan.
authors: Brian T
authors: BT
authors: Taylor
authors: Lakeland HealthCare, Department of Emergency Medicine, St. Joseph MI, Department of Emergency Medicine, Saint Joseph, Michigan.
authors: Michelino
authors: M
authors: Mancini
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D012108:Research Personnel; D018570:Risk Assessment; D014218:Triage; D055815:Young Adult