Emergency Department Assessment of Chest Pain Score (EDACS)
Identifies chest pain patients with low risk of major adverse cardiac event.
- First calculate the score based on patient characteristics and symptom features.
- Next, review the electrocardiogram (ECG) to confirm the absence of new ischemic changes and obtain troponin levels at 0 and 2 hours.
Advice
Barring other concerning features for ACS or other life-threatening causes of chest pain (e.g., pneumothorax, pulmonary embolism, cardiac tamponade, aortic dissection, esophageal rupture), patients who meet low-risk criteria can be considered for discharge after negative 0- and 2-hour troponin testing, with close follow-up arranged with their primary care physician.
Patients who do not meet the low-risk criteria should undergo an MI rule-out in accordance with standard chest pain guidelines and institutional protocols.
Management
- Low risk: Consider other causes of chest pain (e.g., aortic, esophageal, pulmonary, cardiac, abdominal, musculoskeletal sources) prior to discharge.
- Not low risk: Manage according to standard chest pain protocols, including (but not limited to) consideration of aspirin, nitroglycerin, and serial ECGs and cardiac biomarkers at a minimum.
Critical Actions
- Low risk: Patient may be considered for discharge with early outpatient follow-up and further investigation as needed.
- Not low risk: Proceed with usual care and continued observation.