By far, the most promising of the publications to yet emerge from the ADAPT cohort \u2013 1,974 patients evaluated for acute chest pain in the Emergency Department \u2013 is this re-analysis and decision instrument.<\/p>\n
The original ADAPT publication, despite over 80% of the patients having no major cardiac event at 30 days, was only able to identify 20% of patients as \u201clow-risk\u201d. The HEART Score and the Vancouver Chest Pain Rule improve on this, but only incrementally. This publication, however, improves the identification of a low-risk cohort to nearly 50%. By incorporating and weighting 37 different predictor variables, then adding a layer of expert review and acceptability evaluation, these authors ultimately arrive at the \u201cEmergency Department Assessment of Chest Pain Score (EDACS)\u201d. Using age, gender, history, and symptoms, when combined with negative ECG and 0 and 2 hour troponins, a score of 16 constitutes a breakpoint for a decision instrument with ~99% sensitivity and ~55% specificity for MACE at 30 days.<\/p>\n
As far as decision instruments go, it\u2019s relatively reasonable \u2013 although, certainly, nothing you\u2019d be able to keep in your head. Scores for age range from +2 to +20, while four different symptoms and signs have varying positive and negative values. However, in the age of computerized decision-support, at least, mildly complex rules are not as burdensome as they once were.<\/p>\n
I would like to see, at least, prospective validation in a North American population \u2013 but this appears to be a lovely step forward.<\/p>\n
\u201cDevelopment and validation of the Emergency Department Assessment of Chest pain Score and 2 h accelerated diagnostic protocol\u201c By far, the most promising of the publications to yet emerge from the ADAPT cohort \u2013 1,974 patients evaluated for acute chest pain in the Emergency Department \u2013 is this re-analysis and decision instrument. The original ADAPT publication, despite over 80% of the patients having no major cardiac event at 30 days, was only able … Continue reading “ADAPTing & Improving”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[6,7,5],"tags":[],"class_list":["post-3472","post","type-post","status-publish","format-standard","hentry","category-cardiology","category-chest-pain","category-clinical-decision-rules"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7KesJ-U0","jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts\/3472","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3472"}],"version-history":[{"count":0,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts\/3472\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3472"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3472"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3472"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1742-6723.12164\/abstract<\/a><\/p>\n\n