The study authors were able to find a group of low-risk patients (~45%) who could be safely discharged from the ED after 2 biomarkers just 2 hours apart, along with ECG, history, and physical examination. Patients requiring serial blood testing (serial troponin markers, typically at 0 and 6 hours, to rule out myocardial infarction) and further risk stratification require an extended ED evaluation or hospital admission, leading to crowding, bed allocation problems, and exposure of patients to side effects of increased testing. The score was internally validated in the original paper, but has not yet been externally validated. These were added into the EDACS ADP, which includes an ECG and troponin at 0 hours and at 2 hours. The score was initially created without electrocardiogram (ECG) or biomarkers. The fairly extreme goal of ≥ 99% sensitivity was achieved in the study (see the Evidence Appraisal section below). As a rule-out calculator, the EDACS is good at identifying who is relatively safe to go home (highly sensitive), but not good at identifying who does have the disease (not terribly specific). The goal of these rules is to identify a low-risk population of patients who need less testing than other, higher-risk patients. Requiring an emergency revascularization procedure ST-elevation or non-ST-elevation myocardial infarction Like other chest pain evaluation studies, the primary outcome for the EDACS-ADP study was a major adverse cardiac event (MACE), as defined by any of the following: This is a broader definition than other studies, such as the Vancouver Chest Pain Score, which only included chest pain patients. The EDACS accelerated diagnostic protocol (EDACS-ADP) study included any symptoms lasting longer than 5 minutes that the attending physician thought were worth working up for possible acute coronary syndromes (ACS).
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