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Development and validation of the emergency department assessment of chest pain score and 2h accelerated diagnostic protocol
Emergency Medicine Australasia
  • Martin Than, Christchurch Hospital
  • Dylan Flaws, Royal Brisbane and Women's Hospital
  • Sharon Sanders, Bond University
  • Jenny Doust, Bond University
  • Paul Glasziou, Bond University
  • Jeffrey Kline, Indiana University
  • Sally Aldous, Christchurch Hospital
  • Richard Troughton, University of Otago
  • Christopher Reid, Monash University
  • William Parsonage, Royal Brisbane and Women's Hospital
  • Christopher Frampton, University of Otago
  • Jaimi Greenslade, Royal Brisbane and Women's Hospital
  • Joanne Deely, Canterbury District Health Board
  • Erik Hess, Mayo Clinic
  • Amr Bin Sadiq, Christchurch Hospital
  • Rose Singleton, Christchurch Hospital
  • Rosie Shopland, Christchurch Hospital
  • Laura Vercoe, Christchurch Hospital
  • Morgana Woolhouse-Williams, Christchurch Hospital
  • Michael Ardagh, University of Otago
  • P. Bossuyt, University of Amsterdam
  • Laura Bannister, Christchurch Hospital
  • Louise Cullen, Royal Brisbane and Women's Hospital
Date of this Version
2-1-2014
Document Type
Journal Article
Publication Details

Citation only

Than, M., Flaws, D., Sanders, S, Doust, S., Glasziou, P., Kline, J., Aldous, J., Troughton, R., Reid, C., Parsonage, W.A., Frampton, C., Greenslade, J.J., Deely, J.M., Hess, E., Sadiq, A.B., Singleton, R., Shopland, R., Vercoe, L., Woolhouse-Williams, M., Ardagh, M., Bossuyt, P., Bannister, L., & Cullen, L. (2014). Development and validation of the emergency department assessment of chest pain score and 2h accelerated diagnostic protocol. Emergency Medicine Australasia, 26(1), 34-44.

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© Copyright, Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine, 2014

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 2h 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.

Citation Information
Martin Than, Dylan Flaws, Sharon Sanders, Jenny Doust, et al.. "Development and validation of the emergency department assessment of chest pain score and 2h accelerated diagnostic protocol" Emergency Medicine Australasia (2014) ISSN: 1742-6731
Available at: http://works.bepress.com/paul_glasziou/104/