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    ADAPT Protocol for Cardiac Event Risk

    Assesses chest pain patients at 2 hours for risk of cardiac event.
    When to Use
    Pearls/Pitfalls
    Why Use

    The ADAPT Score and Accelerated Diagnostic Protocol can be used to evaluate patients with chest pain and potentially identify 20% of patients who are low-risk and can be evaluated with a 0-hour and 2-hour troponin test along with EKG and TIMI Risk Scores (for STEMI and UA/NSTEMI).

    • Included patients ≥18 years of age with at least 5 minutes of symptoms that could be possible ACS.
    • Patients perceived to be “high risk” were not excluded unless EKG showed ST-Elevation Myocardial Infarction (STEMI).
    • If patient was unsure about a diagnosis (like “history of hypertension,”) this was assumed to be “No.”
    • EKG changes were defined as ST-segment depression of at least 0.05 mV in ≥2 contiguous leads (including reciprocal changes), T-wave inversion of at least 0.1 mV, or Q waves ≥30 ms in width and ≥0.1 mV in depth in at least 2 contiguous leads.
    • 3/4 of patients in the low-risk group still received follow-up testing within 30 days (most with an outpatient stress test).

    Up to 20% of chest pain patients may be able to be safely ruled out for MI and ACS within 2 hours of arrival in the ED, reducing length of stay dramatically without adverse outcome.

    No
    Yes
    No
    Yes
    TIMI Risk Score for UA/NSTEMI
    Note: The TIMI Risk Score for UA/NSTEMI includes cardiac enzymes and ST deviation which are listed above and therefore excluded from the TIMI inputs below.
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes

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    Next Steps
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    Creator Insights
    Dr. Martin Than

    About the Creator

    Martin Than, MD, is an emergency medicine specialist at Christchurch Public Hospital. He is the co-director and co-founder of the Clinical Decision Support Unit and is involved in creating a National Trauma Audit Database and reviewing emergency air ambulance and helicopter services. He has trained and worked in Emergency Medicine in the UK, Canada, Australia and New Zealand.

    To view Dr. Martin Than's publications, visit PubMed

    Are you Dr. Martin Than? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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