Review article: Diagnostic accuracy of risk stratification tools for patients with chest pain in the rural emergency department: A systematic review

Roche, Tina; Jennings, Natasha; Clifford, Stuart; O’Connell, Jane; Lutze, Matthew; Gosden, Edward; Hadden, N Fionna; Gardner, Glenn

doi:10.1111/1742-6723.12622

Cited by 11 publications

(15 citation statements)

References 35 publications

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“…In the EDACS-ADP derivation cohort and subsequent validation studies, this rate ranged from 41.2% to 66.7% [11][12][13]. In studies comparing the chest pain scores in previous emergency services, the EDACS-ADP is one of the best-rated scoring systems [15]. In the presented study, if the authors included patients with an EDACS of 12 or higher in the high-risk group, 41.3% (n = 162) of all patients would be in the low-risk group.…”

Section: Discussionmentioning

confidence: 99%

Clinical utility of EDACS-ADP in patients admitted with chest pain to an emergency department

Akbaş

Çakır

Koçak

et al. 2021

Disaster Emerg Med J

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INTRODUCTION:Acute coronary syndrome (ACS) is a common cause of mortality and morbidity. An ACS diagnosis can be made with electrocardiogram (ECG) and cardiac markers. However, despite medical advances, 2-5% of ACS patients are undiagnosed and discharged from emergency departments (EDs) because clinicians often find it difficult not only to diagnose and treat high-risk patients but also to define nonemergency diseases or safely discharge healthy patients. Risk stratification can be prevented, and inappropriate diagnosis and treatment protocols can be identified. The ED Assessment of Chest Pain Score-Accelerated Diagnostic Protocol (EDACS-ADP) scoring system, developed to identify patients with chest pain but at low risk for a major adverse cardiac event (MACE), is the first score based on clinical data from emergency medicine. AIM:This study investigates the usability of EDACS-ADP in Turkey. MATERIAL AND METHODS:This is a prospective observational study of 392 patients. The primary outcome was a major adverse cardiovascular event (MACE) within thirty days. RESULTS:A total of 116 MACEs occurred in 65 (16,6%) patients during a one-month follow-up. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+ LR), and negative likelihood ratio (-LR) values of the EDACS-ADP score for the evaluation of 30-day MACE rate in patients who admitted with chest pain for two months were as follows: 96.

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Section: Discussionmentioning

confidence: 99%

Clinical utility of EDACS-ADP in patients admitted with chest pain to an emergency department

Akbaş

Çakır

Koçak

et al. 2021

Disaster Emerg Med J

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“…In one review of prospective studies, the HEART score compared to TIMI, GRACE, and NHFA/CSANZ guidelines had highest predictive accuracy for diagnosis of ACS with LR of 13 (95% CI=7.0–24) for high-risk scores (7–10) and LR of 0.20 (95% CI=0.13–0.30) for low-risk scores (0–3) 9. Another review comparing HEART, EDACS, NACPR, TIMI, and GRACE involving patients presenting to rural EDs suggested EDACS performed best,28 although this finding was heavily influenced by results of a single study 15…”

Section: Discussionmentioning

confidence: 99%

“…In comparing risk scores developed from populations with chest pain irrespective of final diagnosis (HEART, NACPR, ADAPT, FPR, EDACS) with those developed in populations with confirmed ACS at discharge (GRACE, TIMI, m.TIMI, PURSUIT), our results confirm that the former, in particular HEART and NACPR, demonstrated superior discriminative performance. Other studies also rate TIMI,24 modified TIMI,10,25 and GRACE10,28 as inferior in stratifying risk.…”

Section: Discussionmentioning

confidence: 99%

Comparison of nine coronary risk scores in evaluating patients presenting to hospital with undifferentiated chest pain

Wamala¹,

Aggarwal²,

Bernard³

et al. 2018

IJGM

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IntroductionWe compared performance of nine risk scores for coronary heart disease (CHD) among patients presenting to an emergency department (ED) with undifferentiated chest pain of possible coronary origin.MethodsA retrospective study was undertaken of adult patients presenting with chest pain to atertiary hospital ED with no electrocardiographs or troponin results diagnostic of ischemic chest pain (ICP) or acute coronary syndrome at ED presentation, and no clearly evident noncoronary diagnosis. Risk scores were applied using cut-points distinguishing low- from high-risk patients according to discharge diagnosis of noncardiac chest pain (NCCP) or ICP, respectively. A lower odds ratio (OR) for ICP denoted lower risk for ICP. Score performance was compared using area under receiver–operator characteristic curves (AUC) and predictive values.ResultsA total of 401 patients were studied, of whom 123 (30.7%) had ICP as final diagnosis. Among the nine risk scores, those with greatest ability to detect low-risk patients were The North American Chest Pain Rule (NACPR) score (OR=0.35, 95% CI=0.27–0.46); History, ECG, Age, Risk Factors, and Troponin (HEART) score (OR=0.43; 95% CI=0.35–0.52); and Thrombolysis in Myocardial Infarction (TIMI) score (OR=0.49; 95% CI=0.41–0.58). Discrimination between patients with NCCP and those with ICP was greatest for HEART score (AUC=0.82; 95% CI=0.78–0.86) and lowest for Accelerated Diagnostic Protocol to Assess Patients with Chest Pain Symptoms Using Contemporary Troponins (ADAPT) score (AUC=0.63; 95% CI=0.58–0.69). In excluding ICP, ADAPT had negative predictive value (NPV) 100% (miss rate 0%) but classified only 1.7% of patients as low risk, compared to NACPR with NPV 98% (miss rate 2%), classifying 10.2% as low risk, and HEART with NPV 94% (miss rate 6%), classifying 32.4% as low risk.ConclusionThe NACPR risk score maximized yield of low-risk patients with lowest miss rate for ICP, while HEART score classified highest proportion of low-risk patients but with a higher miss rate.

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“…Ainda não há um consenso sobre a melhor forma de se investigar ou tratar pacientes com dor torácica, além de ser uma área de constante aprimoramento nas diversas modalidades de como intervir naqueles pacientes onde o infarto do miocárdio é a causa da dor torácica. [1][2][3][4][5][6][7][8][9][10] O estabelecimento de um protocolo clínico no atendimento é essencial no caso de um paciente com dor torácica, principalmente por causa das formas atípicas de apresentação dos sintomas na isquemia do miocárdio, com formas muito variáveis de apresentação clínica entre um indivíduo e outro. 6,9,[11][12][13][14] Por exemplo, considerado o sexo do indivíduo, sabe-se que as mulheres com dor torácica têm, proporcionalmente, em relação aos homens, uma apresentação clínica de sintomatologia dolorosa de origem não isquêmica.…”

Section: Introductionunclassified

Fluxograma utilizado para dor torácica em 523 pacientes admitidos na emergência do Hospital Unimed Recife III

Miranda

Pontes²,

Dantas³

et al. 2021

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Introdução A dor torácica é responsável por mais de 8 milhões de admissões por ano na emergência em hospitais nos EUA. Ainda não há um consenso sobre a melhor forma de se investigar ou tratar pacientes com dor torácica, além de ser uma área de constante aprimoramento nas diversas modalidades de como intervir naqueles pacientes onde o infarto do miocárdio é a causa da dor torácica. Recomenda-se o estabelecimento de um protocolo clínico e seu fluxograma no cuidado dos pacientes com dor torácica na emergência.Objetivo Apresentam o fluxograma utilizado no Hospital da Unimed III, Unimed Recife, Recife, Brasil, para pacientes admitidos na Unidade de Emergência com dor torácica. Com o objetivo de se avaliar dados relacionados com o uso do Protocolo Clínico de Dor Torácica usado no Hospital da Unimed Recife III, verificou-se, para o período de abril a dezembro de 2020, o número de pacientes que entraram no protocolo, quantos foram diagnosticados como infarto do miocárdio com supra ou sem supra, quantos pacientes conseguiram realizar o cateterismo em até 90 minutos e a letalidade. Uma revisão breve sobre dor torácica também foi realizada.Método Dados sobre número de pacientes que entraram no protocolo de dor torácica foi obtido do prontuário eletrônico do paciente (PEP, Business Intelligence). O período estudado foi de 1º de abril até 31 de dezembro de 2020.Resultados Foram 523 pacientes inseridos no protocolo. Dos 523 pacientes com dor torácica, 40 (7,7%) receberam o diagnóstico de infarto do miocárdio, em 19/40 (47,5%) com supra. Em 88% dos pacientes que foram submetidos a um cateterismo cardíaco o tempo porta-balão foi inferior a 90 minutos, mostrando a importância de um Protocolo Clínico na assistência de pacientes cardiológicos. Não houve morte entre os pacientes com infarto do miocárdio.Conclusão Uma parcela significativa de pacientes com dor torácica por infarto do miocárdio recebeu intervenção diagnóstica e tratamento em intervalo de tempo considerado ideal para reperfusão do tecido miocárdico com isquemia. Não houve morte.

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Review article: Diagnostic accuracy of risk stratification tools for patients with chest pain in the rural emergency department: A systematic review

Cited by 11 publications

References 35 publications

Clinical utility of EDACS-ADP in patients admitted with chest pain to an emergency department

Clinical utility of EDACS-ADP in patients admitted with chest pain to an emergency department

Comparison of nine coronary risk scores in evaluating patients presenting to hospital with undifferentiated chest pain

Fluxograma utilizado para dor torácica em 523 pacientes admitidos na emergência do Hospital Unimed Recife III

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