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Emerg Med J. 2016 Sep;33(9):618-25. doi: 10.1136/emermed-2015-205028. Epub 2016 Jul 12.

External validation of the emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP).

Author information

1
Royal Brisbane and Women's Hospital, /'Brisbane, Queensland, Australia.
2
Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand.
3
Department of Emergency Medicine, St Paul's Hospital, British Columbia, Canada; the University of British Columbia, Vancouver, British Columbia, Canada.
4
Department of Emergency Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.
5
Providence Health Care Research Institute, Vancouver, British Columbia, Canada.
6
Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia University of Queensland, Brisbane, Australia Queensland University of Technology, Brisbane, Australia.
7
Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand.
8
Royal Brisbane and Women's Hospital, /'Brisbane, Queensland, Australia University of Queensland, Brisbane, Australia.
9
Canterbury District Health Board, Christchurch, New Zealand.
10
Emergency Department, Christchurch Hospital, Christchurch, New Zealand.

Abstract

OBJECTIVE:

The emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP) facilitates low-risk ED chest pain patients early to outpatient investigation. We aimed to validate this rule in a North American population.

METHODS:

We performed a retrospective validation of the EDACS-ADP using 763 chest pain patients who presented to St Paul's Hospital, Vancouver, Canada, between June 2000 and January 2003. Patients were classified as low risk if they had an EDACS <16, no new ischaemia on ECG and non-elevated serial 0-hour and 2-hour cardiac troponin concentrations. The primary outcome was the number of patients who had a predetermined major adverse cardiac event (MACE) at 30 days after presentation.

RESULTS:

Of the 763 patients, 317 (41.6%) were classified as low risk by the EDACS-ADP. The sensitivity, specificity, negative predictive value and positive predictive value of the EDACS-ADP for 30-day MACE were 100% (95% CI 94.2% to 100%), 46.4% (95% CI 42.6% to 50.2%), 100% (95% CI 98.5% to 100.0%) and 17.5% (95% CI 14.1% to 21.3%), respectively.

CONCLUSIONS:

This study validated the EDACS-ADP in a novel context and supports its safe use in a North American population. It confirms that EDACS-ADP can facilitate progression to early outpatient investigation in up to 40% of ED chest pain patients within 2 hours.

KEYWORDS:

acute coronary syndrome; effectiveness; risk management; statistics

PMID:
27406833
DOI:
10.1136/emermed-2015-205028
[Indexed for MEDLINE]

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