Written by Clay Smith
Spoon Feed
EDACS is accurate and safe to use in practice for chest pain risk stratification and likely allows more patients to be discharged than the HEART score.
Why does this matter?
Chest pain risk scores can help us decide which patients to send home vs staying for further workup. The HEART score has a pooled sensitivity of about 96% and specificity 42%. But in a head-to-head comparison, EDACS and T-MAC were superior to HEART. Also, EDACS is easy to score and has clear, non-subjective criteria. Now that multiple studies have looked at EDACS, what’s the consensus on its accuracy?
Missing heart attacks? Use EDACS…
This was a systematic review and meta-analysis of 8 studies assessing diagnostic accuracy (combined n=11,578). Pooled sensitivity of EDACS was 96.1%, specificity 66.1%. Over half the patients scored were determined to be low risk and eligible for early discharge. Just 0.54% (62/11,578) had MACE within 30 days. With a pretest probability of MACE at around 11% in these combined studies and a negative likelihood ratio of 0.06 with a low-risk EDACS, the calculated post-test probability of missing MACE was around 0.7%. There was some heterogeneity among studies, likely having to do with how certain aspects of EDACS are emphasized or deemphasized at certain study locations, such as assessing chest wall tenderness.
Source
The Diagnostic Accuracy of the Emergency Department Assessment of Chest Pain (EDACS) Score: A Systematic Review and Meta-analysis. Ann Emerg Med. 2021 Apr;77(4):433-441. doi: 10.1016/j.annemergmed.2020.10.020. Epub 2021 Jan 16.
