title: External validation of the emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP).
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Royal Brisbane and Women's Hospital, /'Brisbane, Queensland, Australia.
authors.forename: Dylan
authors.initials: D
authors.lastname: Flaws
authors.affiliation: Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Martin
authors.initials: M
authors.lastname: Than
authors.affiliation: Department of Emergency Medicine, St Paul's Hospital, British Columbia, Canada; the University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Frank Xavier
authors.initials: FX
authors.lastname: Scheuermeyer
authors.affiliation: Department of Emergency Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Christenson
authors.affiliation: Providence Health Care Research Institute, Vancouver, British Columbia, Canada.
authors.forename: Barbara
authors.initials: B
authors.lastname: Boychuk
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia University of Queensland, Brisbane, Australia Queensland University of Technology, Brisbane, Australia.
authors.forename: Jaimi H
authors.initials: JH
authors.lastname: Greenslade
authors.affiliation: Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Sally
authors.initials: S
authors.lastname: Aldous
authors.affiliation: Royal Brisbane and Women's Hospital, /'Brisbane, Queensland, Australia University of Queensland, Brisbane, Australia.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hammett
authors.affiliation: Royal Brisbane and Women's Hospital, /'Brisbane, Queensland, Australia University of Queensland, Brisbane, Australia.
authors.forename: William A
authors.initials: WA
authors.lastname: Parsonage
authors.affiliation: Canterbury District Health Board, Christchurch, New Zealand.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Deely
authors.affiliation: Emergency Department, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: John W
authors.initials: JW
authors.lastname: Pickering
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia University of Queensland, Brisbane, Australia Queensland University of Technology, Brisbane, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001955:British Columbia; D002637:Chest Pain / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D014336:Troponin
keywords: acute coronary syndrome; effectiveness; risk management; statistics