Clinical trial NCT05175144: Diagnostic Performance of "Emergency Department Assessment of Chest Pain Score"
Official title: Diagnostic Performance of "Emergency Department Assessment of Chest Pain Score" in Patients With Acute Chest Pain.
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Acute Chest Pain
Lead sponsor: Assiut University
Sponsor class: OTHER
First posted: 2022-01-03
Enrollment: 146
Sex: ALL
Minimum age (years): 18
Maximum age (years): 90
Standard ages: ADULT
OLDER_ADULT
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Any patient fulfilling the inclusion criteria can participating in our study . .

Brief summary: This study aims to evaluate whether EDACS performed during triage to assess patients with chest pain could improve the predictive validity of triage for an acute cardiovascular event.

Detailed description: Chest pain is common reasons for presentation to the emergency department (ED).Up to 6.3% of emergency department (ED) visits are related to chest pain. Causes of chest pain range from musculoskeletal chest pain to potentially life-threatening emergencies as acute coronary syndrome(ACS), aortic dissection or pulmonary embolism. Therefore, accurate and fast risk stratification is paramount in the acute management, mainly to identify those patients with immediate risk of complications, as those with an ACS. Those patients are challenging to discriminate, as there is a variety of clinical manifestations.

Chest pain is considered to be an acute chest pain, described as pain, pressure, tightness, or burning as outlined in the guidelines Chest pain equivalent symptoms may include dyspnea, left arm, and epigastric pain.

Triage helps recognize the urgency among patients. An accurate triage decision helps patients receive the emergency service in the most appropriate time. Various triage systems have been developed and verified to assist healthcare providers to make accurate triage decisions. Despite good levels of specificity, the available triage systems appear to have suboptimal sensitivities that cannot adequately prioritize patients with acute cardiovascular diseases. The Emergency Department Assessment of Chest Pain Score (EDACS), through a standardized assessment of the patient's history and presenting symptoms only, provides good levels of sensitivity in stratifying time dependent acute cardiovascular diseases. The good discriminatory ability of EDACS, combined with its easy clinical applicability, could be used to overcome some of the limitations of triage systems in assessing chest pain.

Eligibility criteria: Inclusion Criteria:

* Patients \>18 years old who admitted to ED complaining of chest pain.
* Chest pain is considered to be an acute chest pain, described as pain, pressure, tightness, or burning as outlined in the guidelines.
* Chest pain equivalent symptoms may include dyspnea, epigastric pain, and pain in the left arm.

Exclusion Criteria:

* Patients unable to complete the EDACS
* Posttraumatic chest pain
* Patients who did not give consent to participate

Primary outcomes:
measure: Diagnostic performance of EDACS for detection of acute cardiovascular events in emergency department.
timeFrame: baseline
Secondary outcomes:
measure: Baseline characteristics for patients with acute cardiovascular events.
timeFrame: baseline
Other outcomes:
Locations:
Study officials:
References:
citation: Niska R, Bhuiya F, Xu J. National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Natl Health Stat Report. 2010 Aug 6;(26):1-31.
citation: Bayon Fernandez J, Alegria Ezquerra E, Bosch Genover X, Cabades O'Callaghan A, Iglesias Garriz I, Jimenez Nacher JJ, Malpartida De Torres F, Sanz Romero G; Grupo de Trabajo ad hoc de la Seccion de Cardiopatia Isquemica y Unidades Coronarias de la Sociedad Espanola de Cardiologia. [Chest pain units. Organization and protocol for the diagnosis of acute coronary syndromes]. Rev Esp Cardiol. 2002 Feb;55(2):143-54. doi: 10.1016/s0300-8932(02)76574-3. Spanish.
citation: Hinson JS, Martinez DA, Cabral S, George K, Whalen M, Hansoti B, Levin S. Triage Performance in Emergency Medicine: A Systematic Review. Ann Emerg Med. 2019 Jul;74(1):140-152. doi: 10.1016/j.annemergmed.2018.09.022. Epub 2018 Nov 22.
citation: Zaboli A, Ausserhofer D, Sibilio S, Toccolini E, Bonora A, Giudiceandrea A, Rella E, Paulmichl R, Pfeifer N, Turcato G. Effect of the Emergency Department Assessment of Chest Pain Score on the Triage Performance in Patients With Chest Pain. Am J Cardiol. 2021 Dec 15;161:12-18. doi: 10.1016/j.amjcard.2021.08.058. Epub 2021 Oct 9.
citation: Than M, Flaws D, Sanders S, Doust J, Glasziou P, Kline J, Aldous S, Troughton R, Reid C, Parsonage WA, Frampton C, Greenslade JH, Deely JM, Hess E, Sadiq AB, Singleton R, Shopland R, Vercoe L, Woolhouse-Williams M, Ardagh M, Bossuyt P, Bannister L, Cullen L. Development and validation of the Emergency Department Assessment of Chest pain Score and 2 h accelerated diagnostic protocol. Emerg Med Australas. 2014 Feb;26(1):34-44. doi: 10.1111/1742-6723.12164. Epub 2014 Jan 15.
citation: Than MP, Pickering JW, Aldous SJ, Cullen L, Frampton CM, Peacock WF, Jaffe AS, Goodacre SW, Richards AM, Ardagh MW, Deely JM, Florkowski CM, George P, Hamilton GJ, Jardine DL, Troughton RW, van Wyk P, Young JM, Bannister L, Lord SJ. 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.e1. doi: 10.1016/j.annemergmed.2016.01.001.
citation: Flaws D, Than M, Scheuermeyer FX, Christenson J, Boychuk B, Greenslade JH, Aldous S, Hammett CJ, Parsonage WA, Deely JM, Pickering JW, Cullen L. 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. doi: 10.1136/emermed-2015-205028. Epub 2016 Jul 12.