Effectiveness of EDACS Versus ADAPT Accelerated Diagnostic Pathways for Chest Pain: A Pragmatic Randomized Controlled Trial Embedded Within Practice.
STUDY OBJECTIVE A 2 hour accelerated diagnostic pathway based on the Thrombolysis in Myocardial Infarction score, ECG, and troponin measures (ADAPT ADP) increased early discharge of patients with suspected acute myocardial infarction presenting to the emergency department compared with standard care (from 11% to 19.3% Observational studies suggest that an accelerated diagnostic pathway using the Emergency Department Assessment of Chest Pain Score (EDACS ADP) may further increase this proportion. This trial tests for the existence and size of any beneficial effect of using the EDACS ADP in routine clinical care. METHODS This was a pragmatic randomized controlled trial of adults with suspected acute myocardial infarction, comparing the ADAPT ADP and the EDACS ADP. The primary outcome was the proportion of patients discharged to outpatient care within 6 hours of attendance, without subsequent major adverse cardiac event within 30 days. RESULTS Five hundred fifty eight patients were recruited, 279 in each arm. Sixty six patients (11.8% had a major adverse cardiac event within 30 days (ADAPT ADP 29; EDACS ADP 37) 11.1% more patients (95% confidence interval 2.8% to 19.4% were identified as low risk in EDACS ADP (41.6% than in ADAPT ADP (30.5% No low risk patients had a major adverse cardiac event within 30 days (0.0% [0.0% to 1.9% There was no difference in the primary outcome of proportion discharged within 6 hours (EDACS ADP 32.3% ADAPT ADP 34.4% difference 2.1% 10.3% to 6.0% P=.65) CONCLUSION There was no difference in the proportion of patients discharged early despite more patients being classified as low risk by the EDACS ADP than the ADAPT ADP. Both accelerated diagnostic pathways are effective strategies for chest pain assessment and resulted in an increased rate of early discharges compared with previously reported rates.
Annals of emergency medicine