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      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
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    Patent Pending

    Emergency Department Assessment of Chest Pain Score (EDACS)

    Identifies chest pain patients with low risk of major adverse cardiac event.
    When to Use
    Pearls/Pitfalls
    Why Use

    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.

    This score only applies to patients: (1) ≥18 years old with normal vital signs; (2) Chest pain consistent with ACS; (3) No ongoing chest pain or crescendo angina
    years
    Female
    0
    Male
    +6
    No
    0
    Yes
    +4
    Symptoms and signs
    No
    0
    Yes
    +3
    No
    0
    Yes
    +5
    No
    0
    Yes
    -4
    No
    0
    Yes
    -6

    Result:

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    Next Steps
    Evidence
    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

    Dr. Dylan Flaws

    About the Creator

    Dylan Flaws, MSc, PhD, is a psychiatry registrar at the University of Queensland in Brisbane, Australia. He is also an adjunct associate professor at the Queensland University of Technology. Dr. Flaws’ primary research is focused on development of novel delirium screening and management protocols in collaboration with the Critical Care Research Group based at the Prince Charles Hospital in Australia.

    To view Dr. Dylan Flaws's publications, visit PubMed

    Content Contributors
    About the Creator
    Dr. Martin Than
    Dr. Dylan Flaws
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