Bismillah, alhamdulillah: that was the question on my mind as I heard of this score to safely rule out ischemic heart disease within 2 hours! My mind wandered back to the days of hospital medicine and 6 hour Troponins. 2 hours sounded good and it piqued my interest.
Increasingly ER work is being farmed out to family doctors and primary health care centres. With the diminishing costs of fast lab work – it will probably not be too long before someone decides that chest pain of uncertain cause and with stable patients should be worked up more fully at the first point of contact rather than a busy or overworked ER department.
The article being reviewed was recently published in the BMJ and the abstract is given below. You can try out the EDACS score at Mdcalc here.
External validation of the emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP).
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.
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.
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.
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.