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Selected Works of Sally Lord
Article
Effectiveness of EDACS versus ADAPT accelerated diagnostic pathways for chest pain: a pragmatic randomized controlled trial embedded within practice
Annals of Emergency Medicine (2016)
  • Martin P Than, Christchurch Hospital
  • John W Pickering, Christchurch Hospital
  • Sally J Aldous, Christchurch Hospital
  • Louise Cullen, Royal Brisbane and Womens Hospital
  • Christopher Frampton, University of Otago
  • W Frank Peacock, Baylor College of Medicine
  • Allan S Jaffe, Mayo Clinic
  • Steve W Goodacre, University of Sheffield
  • A Mark Richards, University of Otago
  • Michael Ardagh, University of Otago
  • Sally Lord, The University of Notre Dame Australia
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Abstract
Study objective: A 2-hour accelerated diagnostic pathway based on the Thrombolysis in Myocardial Infarction score,
ECG, and troponin measures (ADAPT-ADP) increased early discharge of patients with suspected acute myocardial
infarction presenting to the emergency department compared with standard care (from 11% to 19.3%). Observational
studies suggest that an accelerated diagnostic pathway using the Emergency Department Assessment of Chest Pain
Score (EDACS-ADP) may further increase this proportion. This trial tests for the existence and size of any beneficial
effect of using the EDACS-ADP in routine clinical care.
Methods: This was a pragmatic randomized controlled trial of adults with suspected acute myocardial infarction,
comparing the ADAPT-ADP and the EDACS-ADP. The primary outcome was the proportion of patients discharged to
outpatient care within 6 hours of attendance, without subsequent major adverse cardiac event within 30 days.
Results: Five hundred fifty-eight patients were recruited, 279 in each arm. Sixty-six patients (11.8%) had a major adverse
cardiac event within 30 days (ADAPT-ADP 29; EDACS-ADP 37); 11.1% more patients (95% confidence interval 2.8% to
19.4%) were identified as low risk in EDACS-ADP (41.6%) than in ADAPT-ADP (30.5%). No low-risk patients had a major
adverse cardiac event within 30 days (0.0% [0.0% to 1.9%]). There was no difference in the primary outcome of proportion
discharged within 6 hours (EDACS-ADP 32.3%; ADAPT-ADP 34.4%; difference 2.1% [10.3% to 6.0%], P¼.65).
Conclusion: There was no difference in the proportion of patients discharged early despite more patients being
classified as low risk by the EDACS-ADP than the ADAPT-ADP. Both accelerated diagnostic pathways are effective
strategies for chest pain assessment and resulted in an increased rate of early discharges compared with previously
reported rates.
Disciplines
Publication Date
2016
DOI
10.1016/j.annemergmed.2016.01.001
Citation Information
Than, M., Pickering, J., Aldous, S., Cullen, L., Frampton, C., Peacock, W., Jaffe, A., Goodacre, S., Richards, A., Ardagh, M., Deely, J., Florkowski, C., George, P., Hamilton, G., Jardine, D., Troughton, R., van Wyk, P., Young, J., Bannister, L., and Lord, S. (2016). Effectiveness of EDACS versus ADAPT accelerated diagnostic pathways for chest pain: a pragmatic randomized controlled trial embedded within practice. Annals of Emergency Medicine, 68(1), 93-102. DOI: 10.1016/j.annemergmed.2016.01.001