Key result
Retrospective application of the ADAPT-ADP would have allowed 33.4% of chest pain patients with initially negative ED investigations to be safely discharged, with none developing major adverse cardiac events at 6 months.
Why the study?
Does an accelerated diagnostic protocol (ADAPT-ADP) safely identify low-risk patients for early discharge compared to traditional care in patients admitted with chest pain and negative initial ED workup?
Observational (n=290)
No
Does an accelerated diagnostic protocol (ADAPT-ADP) safely identify low-risk patients for early discharge compared to traditional care in patients admitted with chest pain and negative initial ED workup?
Application of the ADAPT-ADP could safely allow early ED discharge for one-third of chest pain patients with initially negative investigations, avoiding unnecessary hospital admissions and resource utilization.
May support early discharge in low-risk patients; leaves open need for prospective validation before practice change.
PURPOSE: To assess the extent to which accelerated diagnostic protocols (ADPs), compared to traditional care, identify patients presenting to emergency departments (EDs) with chest pain who are at low cardiac risk and eligible for early ED discharge. PATIENTS AND METHODS: Retrospective study of 290 patients admitted to hospital for further evaluation of chest pain following negative ED workup (no acute ischemic electrocardiogram [ECG] changes or elevation of initial serum troponin assay). Demographic data, serial ECG and troponin results, Thrombolysis in Myocardial Infarction (TIMI) score, cardiac investigations, and outcomes (confirmed acute coronary syndrome [ACS] at discharge and major adverse cardiac events [MACEs]) over 6 months of follow-up were analyzed. A validated ADP (ADAPT-ADP) was retrospectively applied to the cohort, and processes and outcomes of ADP-guided care were compared with those of care actually received. RESULTS: Patients had mean (±SD) TIMI score of 1.8 (±1.7); six (2.0%) patients were diagnosed with ACS at discharge. At 6 months, one patient (0.3%) re-presented with ACS and two (0.6%) died of non-coronary causes. The ADAPT-ADP defined 97 (33.4%) patients as being at low risk and eligible for early ED discharge, but who instead incurred mean hospital stay of 1.5 days, with 40.2% in telemetry beds, and 21.6% subject to non-invasive testing with only one positive result for coronary artery disease. None had a discharge diagnosis of ACS or developed MACE at 6 months. CONCLUSION: Compared to traditional care, application of the ADAPT-ADP would have allowed one-third of chest pain patients with initially negative investigations in ED to have been safely discharged from ED.
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Perera et al. (2018) conducted an observational in Chest pain of possible cardiac origin (n=290). ADAPT-ADP (Accelerated Diagnostic Protocol) vs. Traditional care (received care) was evaluated on Proportion of patients identified as low risk and eligible for early discharge. Retrospective application of the ADAPT-ADP would have allowed 33.4% of chest pain patients with initially negative ED investigations to be safely discharged, with none developing major adverse cardiac events at 6 months.
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