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, Jeffery, Aldous, Sally, Troughton, Richard, Reid, Christopher, Parsonage, William A., Frampton, Christopher, Greenslade, Jaimi H., Deely, Joanne M., Hess, Erik, Sadiq, Amr Bin, Singleton, Rose, Shopland, Rosie, Vercoe, Laura, Woolhouse-Williams, Morgana, Ardagh, Michael, Bossuyt, Patrick, Bannister, Laura and Cullen, Louise (2014) Development and validation of the Emergency Department assessment of chest pain score and 2h accelerated diagnostic protocol. EMA - Emergency Medicine Australasia, 26 1: 34-44. doi:10.1111/1742-6723.12164

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Author Than, Martin
Flaws, Dylan
Sanders, Sharon
Doust, Jenny
Glasziou, Paul
Kline, Jeffery
Aldous, Sally
Troughton, Richard
Reid, Christopher
Parsonage, William A.
Frampton, Christopher
Greenslade, Jaimi H.
Deely, Joanne M.
Hess, Erik
Sadiq, Amr Bin
Singleton, Rose
Shopland, Rosie
Vercoe, Laura
Woolhouse-Williams, Morgana
Ardagh, Michael
Bossuyt, Patrick
Bannister, Laura
Cullen, Louise
Title Development and validation of the Emergency Department assessment of chest pain score and 2h accelerated diagnostic protocol
Journal name EMA - Emergency Medicine Australasia   Check publisher's open access policy
ISSN 1742-6731
1742-6723
Publication date 2014-02
Year available 2014
Sub-type Article (original research)
DOI 10.1111/1742-6723.12164
Open Access Status
Volume 26
Issue 1
Start page 34
End page 44
Total pages 11
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Collection year 2015
Language eng
Formatted 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.
Keyword Accelerated diagnostic protocol
Acute coronary syndrome
Emergency department
Major adverse cardiac event
Risk score
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
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