title: Development and validation of the Emergency Department Assessment of Chest pain Score and 2 h accelerated diagnostic protocol.
abstract: OBJECTIVE
  Risk scores and accelerated diagnostic protocols can identify chest pain patients with low risk of major adverse cardiac event who could be discharged early from the ED, saving time and costs. We aimed to derive and validate a chest pain score and accelerated diagnostic protocol (ADP) that could safely increase the proportion of patients suitable for early discharge.
  
  
  METHODS
  Logistic regression identified statistical predictors for major adverse cardiac events in a derivation cohort. Statistical coefficients were converted to whole numbers to create a score. Clinician feedback was used to improve the clinical plausibility and the usability of the final score (Emergency Department Assessment of Chest pain Score [EDACS]). EDACS was combined with electrocardiogram results and troponin results at 0 and 2 h to develop an ADP (EDACS-ADP). The score and EDACS-ADP were validated and tested for reproducibility in separate cohorts of patients.
  
  
  RESULTS
  In the derivation (n = 1974) and validation (n = 608) cohorts, the EDACS-ADP classified 42.2% (sensitivity 99.0%, specificity 49.9%) and 51.3% (sensitivity 100.0%, specificity 59.0%) as low risk of major adverse cardiac events, respectively. The intra-class correlation coefficient for categorisation of patients as low risk was 0.87.
  
  
  CONCLUSIONS
  The EDACS-ADP identified approximately half of the patients presenting to the ED with possible cardiac chest pain as having low risk of short-term major adverse cardiac events, with high sensitivity. This is a significant improvement on similar, previously reported protocols. The EDACS-ADP is reproducible and has the potential to make considerable cost reductions to health systems.
authors.affiliation: Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Martin
authors.initials: M
authors.lastname: Than
authors.forename: Dylan
authors.initials: D
authors.lastname: Flaws
authors.forename: Sharon
authors.initials: S
authors.lastname: Sanders
authors.forename: Jenny
authors.initials: J
authors.lastname: Doust
authors.forename: Paul
authors.initials: P
authors.lastname: Glasziou
authors.forename: Jeffery
authors.initials: J
authors.lastname: Kline
authors.forename: Sally
authors.initials: S
authors.lastname: Aldous
authors.forename: Richard
authors.initials: R
authors.lastname: Troughton
authors.forename: Christopher
authors.initials: C
authors.lastname: Reid
authors.forename: William A
authors.initials: WA
authors.lastname: Parsonage
authors.forename: Christopher
authors.initials: C
authors.lastname: Frampton
authors.forename: Jaimi H
authors.initials: JH
authors.lastname: Greenslade
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Deely
authors.forename: Erik
authors.initials: E
authors.lastname: Hess
authors.forename: Amr Bin
authors.initials: AB
authors.lastname: Sadiq
authors.forename: Rose
authors.initials: R
authors.lastname: Singleton
authors.forename: Rosie
authors.initials: R
authors.lastname: Shopland
authors.forename: Laura
authors.initials: L
authors.lastname: Vercoe
authors.forename: Morgana
authors.initials: M
authors.lastname: Woolhouse-Williams
authors.forename: Michael
authors.initials: M
authors.lastname: Ardagh
authors.forename: Patrick
authors.initials: P
authors.lastname: Bossuyt
authors.forename: Laura
authors.initials: L
authors.lastname: Bannister
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D002985:Clinical Protocols; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D009520:New Zealand; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: accelerated diagnostic protocol; acute coronary syndrome; emergency department; major adverse cardiac event; risk score