Development and validation of the Emergency Department Assessment of Chest pain Score and 2h accelerated diagnostic protocol

Than, Martin, Flaws, Dylan, Sanders, Sharon, Doust, Jenny, Glasziou, Paul, Kline, Jeffrey, Aldous, Sally, Troughton, Richard, Reid, Christopher, Parsonage, William, Frampton, Christopher, Greenslade, Jaimi, Deely, Joanne, Hess, Erik, Sadiq, Amr Bin, Singleton, Rose, Shopland, Rosie, Vercoe, Laura, Woolhouse-Williams, Morgana, Ardagh, Michael, Bossuyt, Patrick, Bannister, Laura, & Cullen, Louise (2014) Development and validation of the Emergency Department Assessment of Chest pain Score and 2h accelerated diagnostic protocol. Emergency Medicine Australasia, 26(1), pp. 34-44.

View at publisher

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.

Conclusion

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.

Impact and interest:

21 citations in Scopus
Search Google Scholar™
22 citations in Web of Science®

Citation counts are sourced monthly from Scopus and Web of Science® citation databases.

These databases contain citations from different subsets of available publications and different time periods and thus the citation count from each is usually different. Some works are not in either database and no count is displayed. Scopus includes citations from articles published in 1996 onwards, and Web of Science® generally from 1980 onwards.

Citations counts from the Google Scholar™ indexing service can be viewed at the linked Google Scholar™ search.

ID Code: 88872
Item Type: Journal Article
Refereed: Yes
DOI: 10.1111/1742-6723.12164
ISSN: 1742-6731
Divisions: Current > Research Centres > Centre for Health Research
Current > QUT Faculties and Divisions > Faculty of Health
Deposited On: 08 Oct 2015 05:19
Last Modified: 08 Oct 2015 05:19

Export: EndNote | Dublin Core | BibTeX

Repository Staff Only: item control page