Effectiveness of EDACS Versus ADAPT Accelerated Diagnostic Pathways for Chest Pain: A Pragmatic Randomized Controlled Trial Embedded Within Practice

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• 作者：Martin P. Than ; MBBS^a ; ^{martinthan@xtra.co.nz" class="auth_mail" title="E-mail the corresponding author} ; John W. Pickering ; PhD^a ; ^b ; Sally J. Aldous ; MBChB ; PhD^a ; Louise Cullen ; MBBS ; PhD^c ; Christopher M.A. Frampton ; PhD^b ; W. Frank Peacock ; MD^d ; Allan S. Jaffe ; MD^e ; Steve W. Goodacre ; PhD^f ; A. Mark Richards ; MD ; PhD^b ; ^g ; Michael W. Ardagh ; PhD^a ; Joanne M. Deely ; PhD^a ; Chris M. Florkowski ; MBBS ; MD^a ; ^b ; Peter George ; MBBS^a ; ^b ; Gregory J. Hamilton ; PhD^a ; David L. Jardine ; MBChB ; DCH^a ; ^b ; Richard W. Troughton ; MBChB ; PhD^a ; ^b ; Pieter van Wyk ; MBChB^a ; Joanna M. Young ; PhD^a ; Laura Bannister ; MBBS^a ; Sally J. Lord ; MBBS^h
• 刊名：Annals of Emergency Medicine
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：68
• 期：1
• 页码：93-102.e1
• 全文大小：1090 K

文摘

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.