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External validation of the emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP)
  1. Dylan Flaws1,
  2. Martin Than2,
  3. Frank Xavier Scheuermeyer3,
  4. James Christenson4,
  5. Barbara Boychuk5,
  6. Jaimi H Greenslade6,7,8,
  7. Sally Aldous9,
  8. Christopher J Hammett1,7,
  9. William A Parsonage1,7,
  10. Joanne M Deely10,
  11. John W Pickering11,
  12. Louise Cullen6,7,8
  1. 1Royal Brisbane and Women's Hospital, /’Brisbane, Queensland, Australia
  2. 2Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand
  3. 3Department of Emergency Medicine, St Paul's Hospital, British Columbia, Canada; the University of British Columbia, Vancouver, British Columbia, Canada
  4. 4Department of Emergency Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  5. 5Providence Health Care Research Institute, Vancouver, British Columbia, Canada
  6. 6Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  7. 7University of Queensland, Brisbane, Australia
  8. 8Queensland University of Technology, Brisbane, Australia
  9. 9Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
  10. 10Canterbury District Health Board, Christchurch, New Zealand
  11. 11Emergency Department, Christchurch Hospital, Christchurch, New Zealand
  1. Correspondence to Dr Dylan Flaws, Royal Brisbane and Women's Hospital, Butterfield St, Herston Brisbane QLD 4029, Australia; Dylan.flaws{at}outlook.com

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.

  • acute coronary syndrome
  • effectiveness
  • risk management
  • statistics

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