Development and validation of the emergency department assessment of chest pain score and 2h accelerated diagnostic protocol

Martin Than, Dylan Flaws, Sharon Sanders, Jenny Doust, Paul Glasziou, Jeffery Kline, Sally Aldous, Richard Troughton, Christopher Reid, William A. Parsonage, Christopher Frampton, Jaimi H. Greenslade, Joanne M. Deely, Erik Hess, Amr Bin Sadiq, Rose Singleton, Rosie Shopland, Laura Vercoe, Morgana Woolhouse-Williams, Michael Ardagh & 3 others Patrick Bossuyt, Laura Bannister, Louise Cullen

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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.

Original languageEnglish
Pages (from-to)34-44
Number of pages11
JournalEMA - Emergency Medicine Australasia
Volume26
Issue number1
DOIs
Publication statusPublished - Feb 2014

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Chest Pain
Hospital Emergency Service
Costs and Cost Analysis
Sensitivity and Specificity
Troponin
Electrocardiography
Logistic Models
Health

Cite this

Than, Martin ; Flaws, Dylan ; Sanders, Sharon ; Doust, Jenny ; Glasziou, Paul ; Kline, Jeffery ; Aldous, Sally ; Troughton, Richard ; Reid, Christopher ; Parsonage, William A. ; Frampton, Christopher ; Greenslade, Jaimi H. ; Deely, Joanne M. ; Hess, Erik ; Sadiq, Amr Bin ; Singleton, Rose ; Shopland, Rosie ; Vercoe, Laura ; Woolhouse-Williams, Morgana ; Ardagh, Michael ; Bossuyt, Patrick ; Bannister, Laura ; Cullen, Louise. / Development and validation of the emergency department assessment of chest pain score and 2h accelerated diagnostic protocol. In: EMA - Emergency Medicine Australasia. 2014 ; Vol. 26, No. 1. pp. 34-44.
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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.",
author = "Martin Than and Dylan Flaws and Sharon Sanders and Jenny Doust and Paul Glasziou and Jeffery Kline and Sally Aldous and Richard Troughton and Christopher Reid and Parsonage, {William A.} and Christopher Frampton and Greenslade, {Jaimi H.} and Deely, {Joanne M.} and Erik Hess and Sadiq, {Amr Bin} and Rose Singleton and Rosie Shopland and Laura Vercoe and Morgana Woolhouse-Williams and Michael Ardagh and Patrick Bossuyt and Laura Bannister and Louise Cullen",
year = "2014",
month = "2",
doi = "10.1111/1742-6723.12164",
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Than, M, Flaws, D, Sanders, S, Doust, J, Glasziou, P, Kline, J, Aldous, S, Troughton, R, Reid, C, Parsonage, WA, Frampton, C, Greenslade, JH, Deely, JM, Hess, E, Sadiq, AB, 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' EMA - Emergency Medicine Australasia, vol. 26, no. 1, pp. 34-44. https://doi.org/10.1111/1742-6723.12164

Development and validation of the emergency department assessment of chest pain score and 2h accelerated diagnostic protocol. / Than, Martin; Flaws, Dylan; Sanders, Sharon; Doust, Jenny; Glasziou, Paul; Kline, Jeffery; Aldous, Sally; Troughton, Richard; Reid, Christopher; Parsonage, William A.; Frampton, Christopher; Greenslade, Jaimi H.; Deely, Joanne M.; Hess, Erik; Sadiq, Amr Bin; Singleton, Rose; Shopland, Rosie; Vercoe, Laura; Woolhouse-Williams, Morgana; Ardagh, Michael; Bossuyt, Patrick; Bannister, Laura; Cullen, Louise.

In: EMA - Emergency Medicine Australasia, Vol. 26, No. 1, 02.2014, p. 34-44.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Development and validation of the emergency department assessment of chest pain score and 2h accelerated diagnostic protocol

AU - Than, Martin

AU - Flaws, Dylan

AU - Sanders, Sharon

AU - Doust, Jenny

AU - Glasziou, Paul

AU - Kline, Jeffery

AU - Aldous, Sally

AU - Troughton, Richard

AU - Reid, Christopher

AU - Parsonage, William A.

AU - Frampton, Christopher

AU - Greenslade, Jaimi H.

AU - Deely, Joanne M.

AU - Hess, Erik

AU - Sadiq, Amr Bin

AU - Singleton, Rose

AU - Shopland, Rosie

AU - Vercoe, Laura

AU - Woolhouse-Williams, Morgana

AU - Ardagh, Michael

AU - Bossuyt, Patrick

AU - Bannister, Laura

AU - Cullen, Louise

PY - 2014/2

Y1 - 2014/2

N2 - 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.

AB - 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.

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DO - 10.1111/1742-6723.12164

M3 - Article

VL - 26

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EP - 44

JO - Emergency Medicine

JF - Emergency Medicine

SN - 1742-6723

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