TY - JOUR
T1 - The Diagnostic Accuracy of the Emergency Department Assessment of Chest Pain (EDACS) Score
T2 - A Systematic Review and Meta-analysis
AU - Boyle, Richard S J
AU - Body, Richard
N1 - Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Dr. Body has undertaken research involving donation of reagents without charge by Roche, Abbott, Alere, and Randox; has accepted speaker fees from Singulex, Alere, and Siemens; and has accepted provision of travel and accommodation to present research findings at conferences from Roche and Randox.
Publisher Copyright:
© 2020 American College of Emergency Physicians
PY - 2021/4/1
Y1 - 2021/4/1
N2 - STUDY OBJECTIVE: We evaluate current evidence for the diagnostic accuracy and safety of the Emergency Department Assessment of Chest Pain Score (EDACS) for patients presenting to the emergency department (ED) with possible acute coronary syndromes.METHODS: MEDLINE, EMBASE, and Cochrane databases were searched for publications reporting data on the EDACS score. No date restrictions were used. Two independent researchers assessed studies for eligibility, bias, and quality. The primary outcome was major adverse cardiac events occurring within 30 days. Heterogeneity was assessed and data were pooled by meta-analysis using a random-effects model.RESULTS: Eight diagnostic test accuracy studies including 11,578 patients and 1 randomized controlled trial including 558 patients were eligible for inclusion. On meta-analysis, the EDACS score had a pooled sensitivity of 96.1% (95% confidence interval 89.6% to 98.6%) and specificity of 61.1% (95% confidence interval 55.5% to 66.3%). A total of 55.0% of patients (n=6,370/11,578) were identified as low risk and eligible for early discharge. Sixty-two patients (0.54%) identified as low risk had an outcome of major adverse cardiac events within 30 days.CONCLUSION: The EDACS score identified greater than 50% of patients with suspected acute coronary syndrome as suitable for discharge after serial troponin sampling during 2 hours. Sensitivity for major adverse cardiac events was relatively high overall and may be acceptable to clinicians.
AB - STUDY OBJECTIVE: We evaluate current evidence for the diagnostic accuracy and safety of the Emergency Department Assessment of Chest Pain Score (EDACS) for patients presenting to the emergency department (ED) with possible acute coronary syndromes.METHODS: MEDLINE, EMBASE, and Cochrane databases were searched for publications reporting data on the EDACS score. No date restrictions were used. Two independent researchers assessed studies for eligibility, bias, and quality. The primary outcome was major adverse cardiac events occurring within 30 days. Heterogeneity was assessed and data were pooled by meta-analysis using a random-effects model.RESULTS: Eight diagnostic test accuracy studies including 11,578 patients and 1 randomized controlled trial including 558 patients were eligible for inclusion. On meta-analysis, the EDACS score had a pooled sensitivity of 96.1% (95% confidence interval 89.6% to 98.6%) and specificity of 61.1% (95% confidence interval 55.5% to 66.3%). A total of 55.0% of patients (n=6,370/11,578) were identified as low risk and eligible for early discharge. Sixty-two patients (0.54%) identified as low risk had an outcome of major adverse cardiac events within 30 days.CONCLUSION: The EDACS score identified greater than 50% of patients with suspected acute coronary syndrome as suitable for discharge after serial troponin sampling during 2 hours. Sensitivity for major adverse cardiac events was relatively high overall and may be acceptable to clinicians.
KW - Acute Coronary Syndrome/diagnosis
KW - Chest Pain/diagnosis
KW - Emergency Service, Hospital
KW - Humans
KW - Risk Assessment/methods
U2 - 10.1016/j.annemergmed.2020.10.020
DO - 10.1016/j.annemergmed.2020.10.020
M3 - Review article
C2 - 33461885
SN - 0196-0644
VL - 77
SP - 433
EP - 441
JO - Annals of Emergency Medicine
JF - Annals of Emergency Medicine
IS - 4
ER -