Emergency Department Assessment of Chest Pain Score (EDACS)

Patients with chest pain or other anginal symptoms requiring evaluation for possible acute coronary syndrome who may be potentially low risk and appropriate for early discharge from the emergency department.

• The EDACS-ADP study included any symptoms >5 minutes that the attending thought were worth working up for possible ACS.
  • This is a broader definition than other studies like the Vancouver Chest Pain Score which only included chest pain patients specifically.
• The EDACS-ADP safely identifies a higher proportion of patients as low-risk for MACE than other ACS clinical decision scores.
• Like other chest pain evaluation studies, the primary outcome was MACE (major adverse cardiac event), as defined by any of the following:
  • ST-elevation or non-ST-elevation MI.
  • Need for emergency revascularization.
  • Death from cardiovascular causes.
  • Ventricular arrhythmia.
  • Cardiac arrest.
  • Cardiogenic shock.
  • High atrio-ventricular block.
• The goal of these rules is to identify a low-risk population that needs less testing than higher-risk patients (it is a rule-out rule to “rule-out” patients at high risk of cardiac disease, and therefore is not terribly specific).
• Goals for sensitivity of the rule were ≥99% and this was achieved in the original study (see Evidence Appraisal).
• The score was created initially without EKG or biomarkers, so that these could then be included in the EDACS-ADP (accelerated diagnostic protocol), which does include EKG and troponin testing at 0h and 2 hours.
• While known CAD and cardiac risk factors are included in the final model for clinical relevance and to improve face validity of the score, note that they were not statistically identified as independent variables in the multivariate logistic regression, and as such there may be a paradoxical decrease in predicted risk after the cutoff age of 50 years. Inclusion of these variables did not affect the tool's performance (Than 2014).

Patients requiring serial blood testing (serial troponin markers typically at 0 and 6-hours to rule out myocardial infarction) and further risk stratification require an extended emergency department evaluation, leading to crowding and bed allocation problems. The authors of this study were able to find a low-risk group of patients (~45%) that could safely be discharged from the ED after two biomarkers, EKG, and history and physical exam.