HEART pathway and Emergency Department Assessment of Chest Pain Score Accelerated Diagnostic Protocol application in a local emergency department of Hong Kong: An external prospective validation study
Background: The conventional chest pain protocol using thrombolysis in myocardial infarction score as the risk stratifying tool may not perform well in the emergency department in which a mix of low and high risk patients are encountered. Newer chest pain scores such as HEART pathway and Emergency Department Assessment of Chest Pain Score Accelerated Diagnostic Protocol (EDACS ADP) are found to have high sensitivity with good specificity. Objectives: This study aims to validate and compare two chest pain scores: HEART pathway and EDACS ADP in the Accident and Emergency Department of a local hospital in Hong Kong. Methods: A prospective cohort study was carried out at the Accident and Emergency Department of Kwong Wah Hospital in Hong Kong from 1 June 2016 to 31 May 2017. Patients 18 years old with chest pain lasting 5 min or more who were observed with chest pain protocol on observation ward were recruited. Results: A total of 238 patients were recruited; 231 eligible patients completed follow up. There were five patients with major adverse cardiac events in 30 days of follow up. The sensitivity, specificity, and negative predictive values of HEART pathway and EDACS ADP were 100% 74.3% 100% and 100% 73.5.0% and 100% respectively. Both scores had almost the same performance in terms of major adverse cardiac events at 30 days (area under the curve 0.87) Conclusion: Our study showed both EDACS ADP (modified) and HEART pathway achieved high sensitivity ~100% for detecting major adverse cardiac events in 30 days while being able to discharge more than 70% of patients as low risk for early discharge.