Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(11), 1303–1309. https://doi.org/10.1002/clc.24126 Dr. Minghu Wang et al.
Points
- The systematic review evaluated the emergency department assessment of chest pain score-accelerated diagnostic protocol (EDACS-ADP) for risk stratification in emergency department (ED) patients with chest pain.
- Analysis of 12 studies involving 14,290 patients revealed that 52.74% were classified as low risk, with only 0.89% experiencing major adverse cardiovascular events (MACE) within 30 days of their ED presentation.
- EDACS-ADP demonstrated a high sensitivity of 0.97 and a specificity of 0.58, a positive diagnostic likelihood ratio (DLR) of 2.34, and a negative DLR of 0.04.
- Despite statistical heterogeneity, the protocol showed potential for clinical application by identifying many low-risk patients suitable for early discharge, with a specificity exceeding 50% and a low incidence of MACE within 30 days of ED presentation.
- The findings emphasize the utility of EDACS-ADP in risk stratification, highlighting its high sensitivity and potential for identifying low-risk patients for early discharge. Thus, they contribute to improved clinical decision-making in managing ED patients with chest pain.
Summary
The systematic review focused on evaluating the effectiveness of the emergency department assessment of chest pain score-accelerated diagnostic protocol (EDACS-ADP) for risk stratification in emergency department (ED) patients with chest pain. The review encompassed a comprehensive search across multiple databases, yielding 12 studies involving 14,290 patients. Among these patients, 52.74% were classified as low risk, with only 0.89% experiencing major adverse cardiovascular events (MACE) within 30 days of their ED presentation, including myocardial infarction, stroke, and cardiovascular death. The combined analysis revealed that EDACS-ADP demonstrated a remarkably high sensitivity of 0.97 (95% confidence interval [CI]: 0.95−0.99), a specificity of 0.58 (0.53−0.63), along with a positive diagnostic likelihood ratio (DLR) of 2.34 and a negative DLR of 0.04. The diagnostic odds ratio was calculated at 53.11, and the summary receiver operating characteristic area under the curve was 0.83, indicating the protocol’s potential for clinical application in identifying low-risk patients for early discharge.
Despite substantial statistical heterogeneity in the results, the EDACS-ADP demonstrated its capability to identify a significant number of low-risk patients suitable for early discharge, with a specificity exceeding 50% and a low incidence of MACE within 30 days of ED presentation. The findings underscore the utility of EDACS-ADP as a valuable tool for risk stratification in ED patients with chest pain, offering promising potential clinical implications for efficient patient management.
This systematic review provides robust and compelling evidence supporting the effectiveness of EDACS-ADP in risk stratification, emphasizing its high sensitivity and potential for identifying low-risk patients suitable for early discharge, thereby contributing to improved clinical decision-making in the management of ED patients presenting with chest pain.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24126
References Wang, M., Hu, Z., Miao, L., Shi, M., & Gao, Q. (2023). A systematic review of the applicability of emergency department assessment of chest pain score-accelerated diagnostic protocol for risk stratification of patients with chest pain. Clinical Cardiology, 46(11), 1303–1309. https://doi.org/10.1002/clc.24126
