title: Performance of the EDACS-accelerated Diagnostic Pathway in a Cohort of US Patients with Acute Chest Pain.
abstract: 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).
  
  
  OBJECTIVE
  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.
authors.affiliation: From the *Department of Emergency Medicine, †Division of Cardiology, Department of Internal Medicine, and ‡Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Stopyra
authors.forename: Chadwick D
authors.initials: CD
authors.lastname: Miller
authors.forename: Brian C
authors.initials: BC
authors.lastname: Hiestand
authors.forename: Cedric W
authors.initials: CW
authors.lastname: Lefebvre
authors.forename: Bret A
authors.initials: BA
authors.lastname: Nicks
authors.forename: David M
authors.initials: DM
authors.lastname: Cline
authors.forename: Kim L
authors.initials: KL
authors.lastname: Askew
authors.forename: Robert F
authors.initials: RF
authors.lastname: Riley
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Russell
authors.forename: James W
authors.initials: JW
authors.lastname: Hoekstra
authors.forename: Simon A
authors.initials: SA
authors.lastname: Mahler
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D015331:Cohort Studies; D019091:Critical Pathways; D003643:Death; D003661:Decision Support Techniques; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D014336:Troponin / Q000097:blood; D014481:United States / Q000453:epidemiology
chemical_list: D014336:Troponin