The Diagnosis of Acute Myocarditis in Emergency (DAME) score: improving diagnostics within the emergency department.

• The diagnosis of myocarditis is challenging at Emergency Department. • D.A.M.E. score may provide fast identification of patients with myocarditis. • DAME score is composed by fever, chest pain, ESR, hs-CRP, troponin, and LVEF. • A score>7 showed higher sensibility, specificity and NPV in myocarditis diagnosis. . The final diagnosis of myocarditis is challenging. The aim of our study was to provide the D.A.M.E. (D iagnosis of A cute M yocarditis in E mergency) Score for the fast identification of patients suffering from myocarditis at Emergency Department (ED). . This was a multicenter, retrospective study involving three centers. All medical records from January 2010 to December 2014 reporting a final discharge diagnosis of myocarditis were considered. One hundred-four patients (mean age: 40.2±16.5 years) were enrolled. Clinical, biochemical and instrumental data were gathered. Data were analysed by means of logistic regression model and factorial analysis. A validation cohort from a fourth center was enrolled. . The final determinants of the DAME score were six: fever, chest pain, erythrocyte sedimentation rate (ESR) > 20 mm/h, C-reactive protein (hs-CRP) >3 mg/L, troponin serum levels >3 ng/L, and left ventricle ejection fraction < 50%. All of them received a specified score ranging from 0 to 4. A score > 4 was related to 75% probability of myocarditis; a final score ranging between 1 and 4 was related to 57% probability of myocarditis. ROC curve on the validation cohort (289 patients, 27 with myocarditis) demonstrated the best cut-off to be 7: AUC 0.958 (p< 0.001), sensibility: 100%, specificity: 85.11%, PPV: 40.9%, NPV: 100% (LR+: 6.72; LR-: 0.00). Logistic regression analysis revealed Odds Ratio equal to 2.83 (95% CI 1.90 – 4.20, p < 0.0001). . DAME score can offer a reliable tool in ED setting for the evaluation of patients suffering from suspected myocarditis. [ABSTRACT FROM AUTHOR]