Emergency Department Detection of Chest Pain Score (EDACS)
Identifies chest pain patients at low-risk for major adverse cardiac events
Author / Source: Riley Golby, MD
The Emergency Department (ED) Detection of Chest Pain Score (EDACS) is a derived and validated accelerated diagnostic protocol designed to identify patients with chest pain who are low-risk for major adverse cardiac events (MACE). In conjunction with an EKG showing no new ischemia and two negative troponins (at 0- and 2-hours), this tool is >99% sensitive for MACE and allows for safe discharge from the ED with outpatient follow-up as appropriate.
The score was derived1 in 2014, and compared to another CDR for chest pain in a prospective RCT2 of 558 patients. The negative predictive value (NPV) in this comparison and subsequent validation study3 was 100%. EDACS is a highly sensitive tool that can reduce patient length of stay and improve identification of low-risk patients presenting with chest pain to the emergency department.
Variable & Associated Points
Age scored as per below, must be 18 or older
- 18 - 45 (+2)
- 46 - 50 (+4)
- 51 - 55 (+6)
- 56 - 60 (+8)
- 61 - 65 (+10)
- 66 - 70 (+12)
- 71 - 75 (+14)
- 76 - 80 (+16)
- 81 - 85 (+18)
- ≥86 (+20)
Sex M/F (male +6; female 0)
Age 18-50 AND known coronary artery disease (CAD) or ≥3 risk factors (Yes +4; No 0)
CAD defined by: previous ACS, previous CABG, or previous PCI
Risk factors defined by: hypertension, dyslipidemia, diabetes, current smoker, family history of early CAD
Diaphoresis (Yes +3, No 0)
Pain radiates to arm, shoulder, neck, or jaw (Yes +5, No 0)
Pain occurred or worsened with inspiration (Yes -4, No 0)
Pain reproduced by palpation (Yes -6, No 0)
The total EDACS score is determined by the sum of variables listed above.
- [1]Than M, Flaws D, Sanders S, et al.: Development and validation of the Emergency Department Assessment of Chest pain Score and 2h accelerated diagnostic protocol.Emerg Med Australas. 2014;24(1):34-44.
- [2]Than M, Pickering JW, Aldous S, et al.: Effectiveness of EDACS Versus ADAPT Accelerated Diagnostic Pathways for Chest Pain: A Pragmatic Randomized Controlled Trial Embedded Within Practice.Ann Emerg Med. 2016 Jul; 68(1):93-102.
- [3]Flaws D, Than M, Scheuermeyer FX et al.: External validation of the emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP)Emerg Med J. 2016 Sep 33(9):618-25.
Results
Real-time automated computation
The Emergency Department (ED) Detection of Chest Pain Score (EDACS) is a derived and validated accelerated diagnostic protocol designed to identify patients with chest pain who are low-risk for major adverse cardiac events (MACE). In conjunction with an EKG showing no new ischemia and two negative troponins (at 0- and 2-hours), this tool is >99% sensitive for MACE and allows for safe discharge from the ED with outpatient follow-up as appropriate.
The score was derived1 in 2014, and compared to another CDR for chest pain in a prospective RCT2 of 558 patients. The negative predictive value (NPV) in this comparison and subsequent validation study3 was 100%. EDACS is a highly sensitive tool that can reduce patient length of stay and improve identification of low-risk patients presenting with chest pain to the emergency department.
Variable & Associated Points
Age scored as per below, must be 18 or older
- 18 - 45 (+2)
- 46 - 50 (+4)
- 51 - 55 (+6)
- 56 - 60 (+8)
- 61 - 65 (+10)
- 66 - 70 (+12)
- 71 - 75 (+14)
- 76 - 80 (+16)
- 81 - 85 (+18)
- ≥86 (+20)
Sex M/F (male +6; female 0)
Age 18-50 AND known coronary artery disease (CAD) or ≥3 risk factors (Yes +4; No 0)
CAD defined by: previous ACS, previous CABG, or previous PCI
Risk factors defined by: hypertension, dyslipidemia, diabetes, current smoker, family history of early CAD
Diaphoresis (Yes +3, No 0)
Pain radiates to arm, shoulder, neck, or jaw (Yes +5, No 0)
Pain occurred or worsened with inspiration (Yes -4, No 0)
Pain reproduced by palpation (Yes -6, No 0)
The total EDACS score is determined by the sum of variables listed above.
- [1]Than M, Flaws D, Sanders S, et al.: Development and validation of the Emergency Department Assessment of Chest pain Score and 2h accelerated diagnostic protocol.Emerg Med Australas. 2014;24(1):34-44.
- [2]Than M, Pickering JW, Aldous S, et al.: Effectiveness of EDACS Versus ADAPT Accelerated Diagnostic Pathways for Chest Pain: A Pragmatic Randomized Controlled Trial Embedded Within Practice.Ann Emerg Med. 2016 Jul; 68(1):93-102.
- [3]Flaws D, Than M, Scheuermeyer FX et al.: External validation of the emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP)Emerg Med J. 2016 Sep 33(9):618-25.