Moving low risk chest pain patients out
September 14, 2016
Short Attention Span Summary
The Study
This was a retrospective application of the EDACS accelerated diagnostic protocol for patients with chest pain that found 41.6% were low risk and the sensitivity and NPV were both 100%. I think this is promising, but as we covered earlier, the EDACS-ADP could classify a patient >65 years old with known CAD “low risk.” That doesn’t seem like a good idea. Also, this was retrospective. It does not tell us that the patients classified as low risk were, in fact, discharged. Our institution uses ADPs but modifies them to account for some of the features we consider to be high risk.
Spoon Feed
The EDACS-ADP was accurate in classifying patients as low risk in this retrospective study.
Dr. Amal Mattu wrote an incredible clinical decision support tool for low-risk chest pain for Evidence Care.
Abstract
Emerg Med J. 2016 Jul 12. pii: emermed-2015-205028. doi: 10.1136/emermed-2015-205028. [Epub ahead of print]
Flaws D1, Than M2, Scheuermeyer FX3, Christenson J4, Boychuk B5, Greenslade JH6, Aldous S7, Hammett CJ8, Parsonage WA8, Deely JM9, Pickering JW10, Cullen L6.
Author information:
1Royal Brisbane and Women’s Hospital, /’Brisbane, Queensland, Australia.
2Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand.
3Department of Emergency Medicine, St Paul’s Hospital, British Columbia, Canada; the University of British Columbia, Vancouver, British Columbia, Canada.
4Department of Emergency Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.
5Providence Health Care Research Institute, Vancouver, British Columbia, Canada.
6Department of Emergency Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia University of Queensland, Brisbane, Australia Queensland University of Technology, Brisbane, Australia.
7Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand.
8Royal Brisbane and Women’s Hospital, /’Brisbane, Queensland, Australia University of Queensland, Brisbane, Australia.
9Canterbury District Health Board, Christchurch, New Zealand.
10Emergency Department, Christchurch Hospital, Christchurch, New Zealand.
Abstract
OBJECTIVE:
The emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP) facilitates low-risk ED chest pain patients early to outpatient investigation. We aimed to validate this rule in a North American population.
METHODS:
We performed a retrospective validation of the EDACS-ADP using 763 chest pain patients who presented to St Paul’s Hospital, Vancouver, Canada, between June 2000 and January 2003. Patients were classified as low risk if they had an EDACS <16, no new ischaemia on ECG and non-elevated serial 0-hour and 2-hour cardiac troponin concentrations. The primary outcome was the number of patients who had a predetermined major adverse cardiac event (MACE) at 30 days after presentation.
RESULTS:
Of the 763 patients, 317 (41.6%) were classified as low risk by the EDACS-ADP. The sensitivity, specificity, negative predictive value and positive predictive value of the EDACS-ADP for 30-day MACE were 100% (95% CI 94.2% to 100%), 46.4% (95% CI 42.6% to 50.2%), 100% (95% CI 98.5% to 100.0%) and 17.5% (95% CI 14.1% to 21.3%), respectively.
CONCLUSIONS:
This study validated the EDACS-ADP in a novel context and supports its safe use in a North American population. It confirms that EDACS-ADP can facilitate progression to early outpatient investigation in up to 40% of ED chest pain patients within 2 hours.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
PMID: 27406833 [PubMed – as supplied by publisher]