Key result
The EDACS-ADP demonstrated a sensitivity of 88.2% (95% CI 63.6-98.5%) for 30-day MACE in US emergency department patients with chest pain, which was deemed insufficiently sensitive for clinical use.
Why the study?
Does the EDACS-ADP safely identify US emergency department patients with symptoms suspicious for acute coronary syndrome for early discharge?
Cohort (n=282)
No
Does the EDACS-ADP safely identify US emergency department patients with symptoms suspicious for acute coronary syndrome for early discharge?
The EDACS-ADP demonstrated insufficient sensitivity (88.2%) for 30-day MACE in a US cohort of ED patients with suspected ACS, failing to validate its safety for early discharge in this population.
EDACS-ADP sensitivity precludes safe early discharge in US ED chest pain patients; leaves open its role pending larger prospective validation.
BACKGROUND: The Emergency Department Assessment of Chest pain Score-Accelerated Diagnostic Protocol (EDACS-ADP) is a decision aid designed to safely identify emergency department (ED) patients with chest pain for early discharge. Derivation and validation studies in Australasia have demonstrated high sensitivity (99%-100%) for major adverse cardiac events (MACE). OBJECTIVES: To validate the EDACS-ADP in a cohort of US ED patients with symptoms suspicious for acute coronary syndrome (ACS). METHODS: A secondary analysis of participants enrolled in the HEART Pathway Randomized Controlled Trial was conducted. This single-site trial enrolled 282 ED patients≥21 years old with symptoms concerning for ACS, inclusive of all cardiac risk levels. Each patient was classified as low risk or at risk by the EDACS-ADP based on EDACS, electrocardiogram, and serial troponins. Potential early discharge rate and sensitivity for MACE at 30 days, defined as cardiac death, myocardial infarction (MI), or coronary revascularization were calculated. RESULTS: MACE occurred in 17/282 (6.0%) participants, including no deaths, 16/282 (5.6%) with MI, and 1/282 (0.4%) with coronary revascularization without MI. The EDACS-ADP identified 188/282 patients [66.7%, 95% confidence interval (CI): 60.8%-72.1%] as low risk. Of these, 2/188 (1.1%, 95% CI: 0.1%-3.9%) had MACE at 30 days. EDACS-ADP was 88.2% (95% CI: 63.6%-98.5%) sensitive for MACE, identifying 15/17 patients. Of the 2 patients identified as low risk with MACE, 1 had MI and 1 had coronary revascularization without MI. CONCLUSIONS: Within a US cohort of ED patients with symptoms concerning for ACS, sensitivity for MACE was 88.2%. We are unable to validate the EDACS-ADP as sufficiently sensitive for clinical use.
No takes yet. Share an insight, caveat, or question.
Stopyra et al. (2015) conducted a cohort in Acute chest pain / symptoms suspicious for acute coronary syndrome (n=282). Emergency Department Assessment of Chest pain Score-Accelerated Diagnostic Protocol (EDACS-ADP) was evaluated on Sensitivity for major adverse cardiac events (MACE) at 30 days (cardiac death, myocardial infarction, or coronary revascularization) (Sensitivity 88.2%, 95% CI 63.6-98.5). The EDACS-ADP demonstrated a sensitivity of 88.2% (95% CI 63.6-98.5%) for 30-day MACE in US emergency department patients with chest pain, which was deemed insufficiently sensitive for clinical use.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: